Provider Demographics
NPI:1285109397
Name:STAATZ, TRICIA (FNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:STAATZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:EILEEN
Other - Last Name:SHARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6427
Mailing Address - Country:US
Mailing Address - Phone:720-718-8410
Mailing Address - Fax:720-718-8999
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6427
Practice Address - Country:US
Practice Address - Phone:720-718-8410
Practice Address - Fax:720-718-8999
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0166709163W00000X
COAPN.0994185-NP363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner