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General NPI Number Information
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NPI Number | 1962243444
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Entity Type | Individual
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Provider Name | NICOLE TUCKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 12596 W BAYAUD AVE STE 100
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City | LAKEWOOD
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State | CO
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Zip | 80228-2035
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Country | US
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Telephone | 720-638-7500
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Fax | 720-812-5134
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Provider Business Mailing Address
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Address Line | 12596 W BAYAUD AVE STE 100
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City | LAKEWOOD
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State | CO
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Zip | 80228-2035
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Country | US
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Telephone | 720-638-7500
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Fax | 720-812-5134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.8882
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0008612
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.8612
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License Number State | CO
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