Provider Demographics
NPI:1801957147
Name:RAMOS, ANTONIO (FNP-C)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 OUTLOOK BLVD
Mailing Address - Street 2:SUITE 37
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1667
Mailing Address - Country:US
Mailing Address - Phone:719-562-6254
Mailing Address - Fax:719-562-6255
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:SUITE 37
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-562-6254
Practice Address - Fax:719-562-6255
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO533790004Medicaid
CO533790004Medicaid
COQ77901Medicare UPIN