Provider Demographics
NPI:1851442453
Name:SKINNER, SHARON ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:SKINNER
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 1:402 N TEJON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1142
Mailing Address - Country:US
Mailing Address - Phone:719-633-3850
Mailing Address - Fax:719-227-0840
Practice Address - Street 1:402 N TEJON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1142
Practice Address - Country:US
Practice Address - Phone:719-633-3850
Practice Address - Fax:719-227-0840
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical