Healthcare Provider Details

I. General information

NPI: 1851099360
Provider Name (Legal Business Name): SAMANTHA JO VIGIL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JO FRANKMORE FNP

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLORADO AVE
PUEBLO CO
81004-2006
US

IV. Provider business mailing address

300 COLORADO AVE
PUEBLO CO
81004-2006
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-8711
  • Fax: 719-543-0171
Mailing address:
  • Phone: 719-543-8711
  • Fax: 719-543-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998465-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: