Provider Demographics
NPI:1902214711
Name:VIGIL, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 NORTH QUEBEC PKWY
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022
Mailing Address - Country:US
Mailing Address - Phone:303-286-8900
Mailing Address - Fax:303-286-8260
Practice Address - Street 1:203 S ROLLIE AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1508
Practice Address - Country:US
Practice Address - Phone:303-286-4560
Practice Address - Fax:303-286-4589
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991199-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner