Provider Demographics
NPI:1659351047
Name:HIMBERGER, JOHN ROBERT (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:HIMBERGER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 STAR RANCH RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7651
Mailing Address - Country:US
Mailing Address - Phone:719-216-3012
Mailing Address - Fax:
Practice Address - Street 1:1400 E BOULDER ST STE 700
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5599
Practice Address - Country:US
Practice Address - Phone:719-365-5000
Practice Address - Fax:719-365-8445
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21276749Medicaid
COCOAAA0627Medicare PIN