Healthcare Provider Details

I. General information

NPI: 1063695013
Provider Name (Legal Business Name): TYLER JOSEPH ALICKS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 FILLMORE ST STE GL1
DENVER CO
80206-1546
US

IV. Provider business mailing address

1633 FILLMORE ST STE GL1
DENVER CO
80206-1546
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-6600
  • Fax: 303-781-4333
Mailing address:
  • Phone: 303-953-6600
  • Fax: 303-781-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3259
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLB-0000216
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0990909-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: