Healthcare Provider Details

I. General information

NPI: 1073489852
Provider Name (Legal Business Name): HALEY NICOLE FISH APRN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 W COLFAX AVE STE B200
LAKEWOOD CO
80215-3736
US

IV. Provider business mailing address

PO BOX 5481
GREENWOOD VILLAGE CO
80155-5410
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.1001131-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: