Provider Demographics
NPI:1972913242
Name:LEITCH, NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:LEITCH
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 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:303-806-1998
Mailing Address - Fax:
Practice Address - Street 1:601 E HAMPDEN AVE STE 500
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2771
Practice Address - Country:US
Practice Address - Phone:303-744-7078
Practice Address - Fax:303-777-4563
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8875493-1206363A00000X
COPA.0003866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant