Provider Demographics
NPI:1619106622
Name:LAUDICK, TANYA LI (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LI
Last Name:LAUDICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 S YOSEMITE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5139
Mailing Address - Country:US
Mailing Address - Phone:970-988-3693
Mailing Address - Fax:877-382-1363
Practice Address - Street 1:6455 S YOSEMITE ST FL 6
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5139
Practice Address - Country:US
Practice Address - Phone:970-988-3693
Practice Address - Fax:877-382-1363
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02608235Medicaid
CO02608235Medicaid