Healthcare Provider Details

I. General information

NPI: 1972414845
Provider Name (Legal Business Name): NICOLE TOTAH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 S OGDEN ST
DENVER CO
80210-5814
US

IV. Provider business mailing address

2380 S OGDEN ST
DENVER CO
80210-5814
US

V. Phone/Fax

Practice location:
  • Phone: 650-339-2708
  • Fax:
Mailing address:
  • Phone: 650-339-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1002180
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: