OrganizationActive
Blue Sage Medical LLC
NPI 1487016226 · Primary Care Nurse Practitioner · Park City, UT
Provider details
- NPI number
- 1487016226
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Gina Coccimiglio, Agpcnp(801) 718-7280
- License
- 123071-4405 (UT)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
6300 Sagewood Dr
Suite H-532
Park City, UT 84098-7502
Phone: (801) 718-7280
Fax: (888) 853-5162
Approximate (ZIP-level) locationGet directions
Mailing address
6300 Sagewood Dr
Park City, UT 84098-7502
Registry dates
- Enumerated
- 2016-03-22
- Last updated
- 2017-08-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.