Provider Demographics
NPI:1740290659
Name:WRISTEN, TAMARA LYNNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNNE
Last Name:WRISTEN
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:PO BOX 173362
Mailing Address - Street 2:CAMPUS BOX 20
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3362
Mailing Address - Country:US
Mailing Address - Phone:303-615-9999
Mailing Address - Fax:720-778-5850
Practice Address - Street 1:1202 5TH ST
Practice Address - Street 2:PLAZA BUILDING, SUITE 150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2006
Practice Address - Country:US
Practice Address - Phone:303-556-2525
Practice Address - Fax:303-556-3881
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant