Provider Demographics
NPI:1083436075
Name:YOO, ANNIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1012 ZODIAC DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7662
Mailing Address - Country:US
Mailing Address - Phone:917-932-7317
Mailing Address - Fax:
Practice Address - Street 1:1605 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2828
Practice Address - Country:US
Practice Address - Phone:719-635-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000252-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily