Healthcare Provider Details

I. General information

NPI: 1780254490
Provider Name (Legal Business Name): TINA MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 GRANT ST STE 210
THORNTON CO
80229-4386
US

IV. Provider business mailing address

9195 GRANT ST STE 210
THORNTON CO
80229-4386
US

V. Phone/Fax

Practice location:
  • Phone: 303-720-0309
  • Fax:
Mailing address:
  • Phone: 303-720-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0997054
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: