Provider Demographics
NPI:1467918268
Name:TINDALL, THEODORE O (MSN, FNP, NP-C, CFRN)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:O
Last Name:TINDALL
Suffix:
Gender:M
Credentials:MSN, FNP, NP-C, CFRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 UINTA WAY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7170
Mailing Address - Country:US
Mailing Address - Phone:303-906-5805
Mailing Address - Fax:
Practice Address - Street 1:20270 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3138
Practice Address - Country:US
Practice Address - Phone:720-386-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993280-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty