Provider Demographics
NPI:1053114454
Name:VANDEMARK, COLLIN ANDREW
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:ANDREW
Last Name:VANDEMARK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 BRUSHY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:GA
Mailing Address - Zip Code:31647-4104
Mailing Address - Country:US
Mailing Address - Phone:229-834-2500
Mailing Address - Fax:
Practice Address - Street 1:2222 N NEVADA AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6794
Practice Address - Country:US
Practice Address - Phone:719-776-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program