Provider Demographics
NPI:1063695013
Name:ALICKS, TYLER JOSEPH (APRN)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JOSEPH
Last Name:ALICKS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 FILLMORE ST STE GL1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1546
Mailing Address - Country:US
Mailing Address - Phone:303-953-6600
Mailing Address - Fax:303-781-4333
Practice Address - Street 1:1633 FILLMORE ST STE GL1
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1546
Practice Address - Country:US
Practice Address - Phone:303-953-6600
Practice Address - Fax:303-781-4333
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3259363LF0000X
DELB-0000216363LF0000X
COAPN.0990909-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7124OtherMEDICARE ID- TYPE UNSPECI
SC372048Medicaid
SC421866Medicare Oscar/Certification
SCAA2408Medicare UPIN
SCAA24087124Medicare PIN