Provider Demographics
NPI:1326397829
Name:VIGIL, JONATHON F (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:F
Last Name:VIGIL
Suffix:
Gender:M
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 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:303-814-6491
Practice Address - Street 1:7280 LAGAE RD STE J
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9454
Practice Address - Country:US
Practice Address - Phone:303-814-0505
Practice Address - Fax:303-814-6491
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2012-0053363A00000X
363AM0700X, 363AS0400X
COPA.0007116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77873785Medicaid
NM1108292OtherNCCPA
NM1108292OtherNCCPA