Provider Demographics
NPI:1568686137
Name:PLOTKIN, TATYANA (NP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:PLOTKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 S UINTA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2742
Mailing Address - Country:US
Mailing Address - Phone:303-807-5021
Mailing Address - Fax:
Practice Address - Street 1:6850 E EVANS AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2300
Practice Address - Country:US
Practice Address - Phone:303-691-5009
Practice Address - Fax:303-691-8897
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15733183500000X
COAPN.0999138.NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO109991OtherDH HOSPITAL PROVIDER #