Provider Demographics
NPI:1104509785
Name:CASTRO HUMPHRIES, MICHELLE ELAINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:CASTRO HUMPHRIES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 POLEPLANT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5251
Mailing Address - Country:US
Mailing Address - Phone:719-654-6890
Mailing Address - Fax:
Practice Address - Street 1:4880 POLEPLANT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5251
Practice Address - Country:US
Practice Address - Phone:719-654-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0998953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily