Provider Demographics
NPI:1023253341
Name:JAGGARS, AMMIE (LSA)
Entity type:Individual
Prefix:
First Name:AMMIE
Middle Name:
Last Name:JAGGARS
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:AMMIE
Other - Middle Name:J
Other - Last Name:JAGGARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSA
Mailing Address - Street 1:9451 E. WINDING HILL AVE.
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:832-881-8856
Mailing Address - Fax:
Practice Address - Street 1:9451 E WINDING HILL AVE
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8472
Practice Address - Country:US
Practice Address - Phone:832-881-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00320246ZS0410X
COSA0002225246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty