Provider Demographics
NPI:1568713683
Name:HOSACK, HEATHER LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:HOSACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4342
Mailing Address - Country:US
Mailing Address - Phone:303-403-3670
Mailing Address - Fax:303-403-6489
Practice Address - Street 1:8550 W 38TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4342
Practice Address - Country:US
Practice Address - Phone:303-403-3670
Practice Address - Fax:303-403-6489
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant