Provider Demographics
NPI:1821640061
Name:TIBBETTS, ALICE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ELIZABETH
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ELIZABETH
Other - Last Name:GRUBB JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 PURCELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601
Mailing Address - Country:US
Mailing Address - Phone:303-659-9700
Mailing Address - Fax:
Practice Address - Street 1:2900 E 136TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3542
Practice Address - Country:US
Practice Address - Phone:303-996-6005
Practice Address - Fax:303-420-8831
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant