Provider Demographics
NPI:1114278025
Name:TERCAN, DIANNA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYNN
Last Name:TERCAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:LYNN
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:719-635-7172
Mailing Address - Fax:719-444-3759
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-635-7172
Practice Address - Fax:719-444-3759
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03820363AM0700X
COPA.0004565363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical