Individual
ASHLEY VANDERJAGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MMS
Contact information
Practice address
2312 N NEVADA AVE STE 100, COLORADO SPRINGS, CO 80907-5307
(719) 473-3272
(719) 389-1191
Mailing address
2312 N NEVADA AVE STE 100, COLORADO SPRINGS, CO 80907-5307
(719) 473-3272
(719) 389-1191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004855
CO
363AM0700X
Medical Physician Assistant
PA.0004855
CO
363AS0400X
Surgical Physician Assistant
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15605817
—
CO
Enumeration date
10/18/2016
Last updated
01/28/2025
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