IndividualActive
Jacob Ellis, PA-C
NPI 1407730765 · Vascular Surgery Physician · Colorado Springs, CO
Provider details
- NPI number
- 1407730765
- Entity type
- Individual
- Primary specialty
- Vascular Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- Yes
- License
- 1234 (CO)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
7808 Ultra Dr
Colorado Springs, CO 80920-8058
Phone: (719) 209-5569
Approximate (ZIP-level) locationGet directions
Mailing address
7808 Ultra Dr
Colorado Springs, CO 80920-8058
Registry dates
- Enumerated
- 2025-07-31
- Last updated
- 2025-07-31
- Certified
- 2025-07-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.