Provider Demographics
NPI:1700591534
Name:EQUITZ, EMILY REBECCA (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:EQUITZ
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 S DOWNING ST STE 380
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5850
Mailing Address - Country:US
Mailing Address - Phone:303-778-5797
Mailing Address - Fax:303-778-5205
Practice Address - Street 1:2535 S DOWNING ST STE 380
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5850
Practice Address - Country:US
Practice Address - Phone:303-778-5797
Practice Address - Fax:303-778-5205
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
COPA.0007727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0007727OtherCO LICENSE