Provider Demographics
NPI:1316052814
Name:VANSICKLE, TAMITHA R (MD)
Entity type:Individual
Prefix:
First Name:TAMITHA
Middle Name:R
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 TRAILSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8701
Mailing Address - Country:US
Mailing Address - Phone:303-903-1613
Mailing Address - Fax:
Practice Address - Street 1:2201 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2047
Practice Address - Country:US
Practice Address - Phone:561-548-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036172265207L00000X
CO44283207L00000X
FLME174300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08007829Medicaid
COCOA108446Medicare PIN