Provider Demographics
NPI:1568531234
Name:GILLESPIE, HEIDI (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:MANZONIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:750 W HAMPDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2167
Mailing Address - Country:US
Mailing Address - Phone:303-945-3299
Mailing Address - Fax:303-945-3303
Practice Address - Street 1:20270 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3138
Practice Address - Country:US
Practice Address - Phone:303-680-0664
Practice Address - Fax:303-693-2043
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV568363AM0700X
CO3796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29270065Medicaid
NVS81190Medicare UPIN