Healthcare Provider Details

I. General information

NPI: 1285109397
Provider Name (Legal Business Name): TRICIA STAATZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRICIA EILEEN SHARKEY

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S MAIN ST
LONGMONT CO
80501-6427
US

IV. Provider business mailing address

601 S MAIN ST
LONGMONT CO
80501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-8410
  • Fax: 720-718-8999
Mailing address:
  • Phone: 720-718-8410
  • Fax: 720-718-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0166709
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0994185-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994185-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: