Provider Demographics
NPI:1306873898
Name:ENGLE, TANIA ERIKA (PA-C)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:ERIKA
Last Name:ENGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GLEN ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1512
Mailing Address - Country:US
Mailing Address - Phone:303-981-7083
Mailing Address - Fax:
Practice Address - Street 1:50 BUCK CREEK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-4330
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1618363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87158574Medicaid