Healthcare Provider Details

I. General information

NPI: 1972097418
Provider Name (Legal Business Name): TYLER NICKLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 RESEARCH PKWY STE 205
COLORADO SPRINGS CO
80920-1093
US

IV. Provider business mailing address

2430 RESEARCH PKWY STE 205
COLORADO SPRINGS CO
80920-1093
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-6242
  • Fax: 719-445-6332
Mailing address:
  • Phone: 719-445-6242
  • Fax: 719-445-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20A19690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDR.0074892
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDR.0074892
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: