Provider Demographics
NPI:1679296917
Name:FITZSIMMONS, SEAN ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANDREW
Last Name:FITZSIMMONS
Suffix:
Gender:M
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 1:1080 CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1850
Mailing Address - Country:US
Mailing Address - Phone:719-564-9400
Mailing Address - Fax:
Practice Address - Street 1:1080 CHINOOK LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1850
Practice Address - Country:US
Practice Address - Phone:719-564-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant