Provider Demographics
NPI:1760723522
Name:KLOSTERMAN, TIFFANY JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JEAN
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-2767
Mailing Address - Country:US
Mailing Address - Phone:720-432-4419
Mailing Address - Fax:308-646-0168
Practice Address - Street 1:2101 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4444
Practice Address - Country:US
Practice Address - Phone:308-762-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60325568363A00000X
COPA0005373363A00000X
NE2388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant