Individual
NICOLE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12596 W BAYAUD AVE STE 100, LAKEWOOD, CO 80228-2035
(720) 638-7500
(720) 812-5134
Mailing address
12596 W BAYAUD AVE STE 100, LAKEWOOD, CO 80228-2035
(720) 638-7500
(720) 812-5134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.8612
CO
363A00000X
Physician Assistant
PA.8882
CO
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
PA.0008612
CO
Other
Enumeration date
06/06/2024
Last updated
02/10/2025
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