Healthcare Provider Details

I. General information

NPI: 1497188569
Provider Name (Legal Business Name): TAMARA P REEVES-SANDOVAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY REEVES-SANDOVAL NP

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 COLE BLVD STE 100
GOLDEN CO
80401-3219
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-4900
  • Fax: 303-763-5495
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0990726-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: