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NPI Code Detail

MEDICARE: NICOLE TUCKER PA-C

MEDICARE: NICOLE TUCKER PA-C
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
1363A00000XPhysician Assistant
2363A00000XPhysician AssistantPA.8882CO
3363AS0400XSurgical Physician AssistantPA.0008612CO
4363A00000XPhysician AssistantPA.8612CO

General Provider Information

NPI Number : 1962243444
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE TUCKER PA-C
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 : 720-638-7500
Fax Number : 720-812-5134
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 : 720-638-7500
Fax Number : 720-812-5134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2024
Last Update Date : 02/10/2025

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Directions to “ NICOLE TUCKER PA-C” Practice Location

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