Provider Demographics
NPI:1063050656
Name:ZITZ, TASHARA JAKEIYA
Entity type:Individual
Prefix:
First Name:TASHARA
Middle Name:JAKEIYA
Last Name:ZITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHARA
Other - Middle Name:JAKEIYA
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7280 LAGAE RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9452
Mailing Address - Country:US
Mailing Address - Phone:303-814-0505
Mailing Address - Fax:
Practice Address - Street 1:7280 LAGAE RD
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9452
Practice Address - Country:US
Practice Address - Phone:303-813-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853352163W00000X
FLAPRN11006929363L00000X, 363LF0000X
TXAP144664363LF0000X
COC-APN.0002352-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner