Individual provider Active NPI

Maisha Dollison Tagoilelagi, FNP

  • Primary Care Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1255689998
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APN-0000212-C-NP Issued in CO
Practice address
3141 Centennial Blvd
Colorado Springs, CO 80907-4094
Phone
(719) 327-5660
NPI assigned
Aug 28, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X APN-0000212-C-NP CO
Family Nurse Practitioner 363LF0000X APN-0000212-C-NP CO
Primary Care Nurse Practitioner 363LP2300X APN-0000212-C-NP CO Primary

Addresses

Primary practice location

3141 Centennial Blvd
Colorado Springs, CO 80907-4094

Mailing address

8448 Roaring Fork Dr
Colorado Springs, CO 80924-8105
Phone (719) 510-2578

Other practice location 1

444 W Fort St.
Fl. 2
Boise, ID 83702-4535
Phone (208) 422-1018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211004001249 CO Order and Referring Only - Nurse Practitioner 2365687977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN-0000212-C-NPCOMDPrimary Care Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1255689998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8448 ROARING FORK DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809248105",
            "telephone_number": "719-510-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3141 CENTENNIAL BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809074094",
            "telephone_number": "719-327-5660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 W Fort St.",
            "address_2": "Fl. 2",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024535",
            "country_code": "US",
            "telephone_number": "208-422-1018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAGOILELAGI",
        "first_name": "MAISHA",
        "middle_name": "DOLLISON",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-28",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "APN-0000212-C-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN-0000212-C-NP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "APN-0000212-C-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.