Provider Demographics
NPI:1235484759
Name:LUDWICK, TIFFANY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:LUDWICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3825 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3316
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:405-341-3795
Practice Address - Street 1:3825 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3316
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2535363A00000X
COPA.0006193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant