Provider Demographics
NPI:1669734521
Name:VANBOXTEL, BRIDGET ANN (PA-C)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:VANBOXTEL
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 1:1321 E 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3923
Mailing Address - Country:US
Mailing Address - Phone:720-878-7271
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE STE 3300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1239
Practice Address - Country:US
Practice Address - Phone:303-837-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004783363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC290508Medicare UPIN