Provider Demographics
NPI:1215708532
Name:ZIMMERMAN, CORA (PA-C)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 LAKE VIEW CIR W
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8811
Mailing Address - Country:US
Mailing Address - Phone:970-389-6821
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR STE 180
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5948
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:970-668-4406
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant