Provider Demographics
NPI:1891340709
Name:CAMACHO, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 FLINTRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1870
Mailing Address - Country:US
Mailing Address - Phone:719-445-9902
Mailing Address - Fax:719-387-0312
Practice Address - Street 1:5770 FLINTRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1881
Practice Address - Country:US
Practice Address - Phone:719-445-9902
Practice Address - Fax:719-387-0312
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008635363A00000X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program