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1033558101

NPI Code Detail

MEDICARE: TESSA SUZANNE HENDERSON NP

MEDICARE: TESSA SUZANNE HENDERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APN.0990650-NP	CO
2	363LG0600X	Gerontology Nurse Practitioner	APN.0990650-NP	CO
3	363LF0000X	Family Nurse Practitioner	APN.0990650-NP	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	384572YQ3L	OTHER	CO	MEDICARE
2	384572YQN9	OTHER	CO	MEDICARE
3	384572YQPG	OTHER	CO	MEDICARE

General Provider Information

NPI Number	:	1033558101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA SUZANNE HENDERSON NP

Provider Business Mailing Address
First Line	:	12596 W BAYAUD AVE STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2035
Country	:	US
Telephone Number	:	303-649-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	12596 W BAYAUD AVE STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2035
Country	:	US
Telephone Number	:	303-649-3050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	08/04/2025

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Directions to “ TESSA SUZANNE HENDERSON NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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