Provider Demographics
NPI:1679071310
Name:PASCARELLA, JUDITH ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:PASCARELLA
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:EVANS ARMY COMMUNITY HOSPITAL, 1650 COCHRANE CIR
Mailing Address - Street 2:B7500
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-4911
Mailing Address - Fax:
Practice Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL, 1650 COCHRANE CIR
Practice Address - Street 2:B7500
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant