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General NPI Number Information
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NPI Number | 1205203098
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Entity Type | Individual
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Provider Name | NANCY PRANTL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 410 GOLD PASS HTS
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3882
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Country | US
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Telephone | 719-632-5700
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Fax | 719-344-7817
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Provider Business Mailing Address
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Address Line | 3205 N ACADEMY BLVD SUITE 130
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-5101
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Country | US
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Telephone | 719-344-7158
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Fax | 719-344-7837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0991893-NP
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License Number State | CO
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