Healthcare Provider Details

I. General information

NPI: 1235863028
Provider Name (Legal Business Name): ERNESHA TENICKI WOLF NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 ASHTON PARK PL
COLORADO SPRINGS CO
80919-4816
US

IV. Provider business mailing address

1050 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 979-574-8309
  • Fax:
Mailing address:
  • Phone: 573-458-8899
  • Fax: 573-341-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026006594
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0997664-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997664-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: