Healthcare Provider Details

I. General information

NPI: 1194058933
Provider Name (Legal Business Name): TIFFANY ANN NELSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ANN LISKO

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E WOODMEN RD
COLORADO SPRINGS CO
80923-2601
US

IV. Provider business mailing address

6001 E WOODMEN RD
COLORADO SPRINGS CO
80923-2601
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-3276
  • Fax: 719-571-3213
Mailing address:
  • Phone: 719-571-3276
  • Fax: 719-571-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0002416
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0002416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: