Provider Demographics
NPI:1750914883
Name:ARCHULETA, TANYA MICHELLE
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MICHELLE
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11636 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5816
Mailing Address - Country:US
Mailing Address - Phone:719-480-3333
Mailing Address - Fax:
Practice Address - Street 1:11636 CLERMONT ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5816
Practice Address - Country:US
Practice Address - Phone:719-480-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1664477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse