Provider Demographics
NPI:1801352968
Name:CONTRERAS, TIFANIE (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFANIE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9561 GHOST FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1173
Mailing Address - Country:US
Mailing Address - Phone:719-200-7779
Mailing Address - Fax:
Practice Address - Street 1:6455 S YOSEMITE ST FL 6
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5139
Practice Address - Country:US
Practice Address - Phone:720-441-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0198576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26-0683057Medicaid