NPIMap

Individual provider Active NPI

Nicole Tucker, PA-C

  • Physician Assistant
  • Lakewood, CO
National Provider Identifier
1962243444
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.8612 Issued in CO
Practice address
12596 W Bayaud Ave Ste 100
Lakewood, CO 80228-2035
Phone
(720) 638-7500
Fax
(720) 812-5134
NPI assigned
Jun 6, 2024
Last updated
Feb 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X PA.8882 CO
Physician Assistant 363A00000X PA.8612 CO Primary
Surgical Physician Assistant 363AS0400X PA.0008612 CO

Addresses

Primary practice location

12596 W Bayaud Ave Ste 100
Lakewood, CO 80228-2035

Mailing address

12596 W Bayaud Ave Ste 100
Lakewood, CO 80228-2035
Phone (720) 638-7500

Other practice location 1

11750 W 2nd Pl Ste 255
Lakewood, CO 80228-1726
Phone (720) 638-7500

Other practice location 2

2352 Meadows Blvd Ste 300
Castle Rock, CO 80109-8419
Phone (720) 638-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813002280 CO Practitioner - Physician Assistant 9032657747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2525 S Downing St
Denver, CO 80210-5817

2535 D S Downing St
Suite 460
Denver, CO 80210-5817
Phone (303) 744-1065

2535 S Downing St
Denver, CO 80210-5850
Phone (303) 778-5797

7700 S Broadway
Littleton, CO 80122-2602
Phone (303) 730-8900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.8612COMDPhysician Assistant
PA.0008612COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgery One PC CurrentSince Aug 1, 2024 Accepting new patients
Portercare Adventist Health System CurrentSince Dec 7, 2024 Accepting new patients
Portercare Adventist Health System CurrentSince Dec 7, 2024 Accepting new patients
Neurosurgery One PC CurrentSince Aug 1, 2024 Accepting new patients
Portercare Adventist Health System Single Specialty Past Accepting new patients

Locations

2352 Meadows Blvd
Ste 300
Castle Rock, CO 80109
Phone (303) 744-1961

11750 W 2nd Pl
Ste 255
Lakewood, CO 80228
Phone (303) 629-5600

12596 W Bayaud Ave
Ste 100
Lakewood, CO 80228
Phone (303) 551-4156

7780 S Broadway
Ste 350
Littleton, CO 80122
Phone (303) 734-8650

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1962243444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12596 W BAYAUD AVE STE 100",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282035",
            "telephone_number": "720-638-7500",
            "fax_number": "720-812-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12596 W BAYAUD AVE STE 100",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282035",
            "telephone_number": "720-638-7500",
            "fax_number": "720-812-5134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11750 W 2nd Pl Ste 255",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802281726",
            "country_code": "US",
            "telephone_number": "720-638-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2352 Meadows Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Castle Rock",
            "state": "CO",
            "postal_code": "801098419",
            "country_code": "US",
            "telephone_number": "720-638-7500",
            "fax_number": "720-484-6918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.8882",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.8612",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0008612",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.