Provider Demographics
NPI:1639797335
Name:WAGNER, BRIANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:
Other - Last Name:HOFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2446 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1087
Mailing Address - Country:US
Mailing Address - Phone:719-209-2577
Mailing Address - Fax:
Practice Address - Street 1:2446 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1087
Practice Address - Country:US
Practice Address - Phone:719-623-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995656-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily