Provider Demographics
NPI:1073039376
Name:REPASS, AMBRIA (APN)
Entity Type:Individual
Prefix:
First Name:AMBRIA
Middle Name:
Last Name:REPASS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 LAKE SONG LN UNIT S4
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6555
Mailing Address - Country:US
Mailing Address - Phone:309-945-8019
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN PLZ
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2745
Practice Address - Country:US
Practice Address - Phone:210-223-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993251363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0993251OtherAPN