Provider Demographics
NPI:1699287953
Name:TUCHOWSKI, CAROLINE KELLY (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KELLY
Last Name:TUCHOWSKI
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 1:5224 RIM ROCK LN # H4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5043
Mailing Address - Country:US
Mailing Address - Phone:906-282-3976
Mailing Address - Fax:
Practice Address - Street 1:2121 E HARMONY RD UNIT 360
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3404
Practice Address - Country:US
Practice Address - Phone:970-267-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant