Provider Demographics
NPI:1285100479
Name:NICKELS, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:NICKELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 FLORIDA RD STE 203C
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6860
Mailing Address - Country:US
Mailing Address - Phone:866-740-0607
Mailing Address - Fax:
Practice Address - Street 1:1120 E ELIZABETH ST STE G2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:970-639-4475
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant