Provider Demographics
NPI:1811688088
Name:JEFFERS, ANGELICA OCHOA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:OCHOA
Last Name:JEFFERS
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 1:2955 PROFESSIONAL PL STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8140
Mailing Address - Country:US
Mailing Address - Phone:719-591-5545
Mailing Address - Fax:
Practice Address - Street 1:2955 PROFESSIONAL PL STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8140
Practice Address - Country:US
Practice Address - Phone:719-591-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15862363A00000X
COMSPA.0000010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant