Healthcare Provider Details

I. General information

NPI: 1700470101
Provider Name (Legal Business Name): TYLER ANDERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 S BROADWAY
LITTLETON CO
80122-2602
US

IV. Provider business mailing address

2781 S NEWLAND ST
DENVER CO
80227-3518
US

V. Phone/Fax

Practice location:
  • Phone: 800-828-0898
  • Fax:
Mailing address:
  • Phone: 303-941-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007470
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: