Provider Demographics
NPI:1699849315
Name:BOLINGER, GINA STECINA (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:STECINA
Last Name:BOLINGER
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 1:3655 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4469
Mailing Address - Country:US
Mailing Address - Phone:303-254-8500
Mailing Address - Fax:303-453-4994
Practice Address - Street 1:3655 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4469
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-4994
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1022363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1022OtherSTATE LICENSE NUMBER