Provider Demographics
NPI:1982296885
Name:ULRICH, TATE B (MSN, PHMNP-BC, CIPP)
Entity type:Individual
Prefix:MRS
First Name:TATE
Middle Name:B
Last Name:ULRICH
Suffix:
Gender:
Credentials:MSN, PHMNP-BC, CIPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630493
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0493
Mailing Address - Country:US
Mailing Address - Phone:720-469-2845
Mailing Address - Fax:720-222-5729
Practice Address - Street 1:1510 W CANAL CT STE 2500
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5639
Practice Address - Country:US
Practice Address - Phone:720-469-2845
Practice Address - Fax:720-222-5729
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997827-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000208063Medicaid