Provider Demographics
NPI:1730295221
Name:FLAVIN, EILEEN ANN (FNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANN
Last Name:FLAVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ANN
Other - Last Name:FLAVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:719-365-2887
Mailing Address - Fax:719-365-5000
Practice Address - Street 1:4735 BYWOOD CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5936
Practice Address - Country:US
Practice Address - Phone:719-285-6022
Practice Address - Fax:719-368-6202
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102301363LF0000X
COAPN.0004367-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO811174Medicare PIN