Provider Demographics
NPI:1922316017
Name:SPARGUR, COLLEEN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ROSE
Last Name:SPARGUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ROSE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 N ESTRELLA PKWY STE 60
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9279
Mailing Address - Country:US
Mailing Address - Phone:623-321-5079
Mailing Address - Fax:623-321-5083
Practice Address - Street 1:750 N ESTRELLA PKWY STE 60
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9279
Practice Address - Country:US
Practice Address - Phone:623-321-5079
Practice Address - Fax:623-321-5083
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6697363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical