Individual
ANNIKA SVEA KOSTRUBALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2121 E HARMONY RD UNIT 300, FORT COLLINS, CO 80528
(970) 224-9102
(970) 224-9112
Mailing address
2121 E HARMONY RD UNIT 300, FORT COLLINS, CO 80528-3403
(970) 224-9102
(970) 224-9112
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2701
SC
363A00000X
Physician Assistant
Primary
PA.0004033
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1433PA
—
SC
05
—
1750647244
—
NC
05
—
66758076
—
CO
Enumeration date
04/09/2012
Last updated
01/08/2024
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