Healthcare Provider Details

I. General information

NPI: 1023691490
Provider Name (Legal Business Name): CULTIVATE MENTAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GARDEN CTR STE 138
BROOMFIELD CO
80020-1790
US

IV. Provider business mailing address

80 GARDEN CTR STE 138
BROOMFIELD CO
80020-1790
US

V. Phone/Fax

Practice location:
  • Phone: 720-415-0101
  • Fax: 833-967-2490
Mailing address:
  • Phone: 720-415-0101
  • Fax: 833-967-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TANYA S TANNER
Title or Position: NP
Credential:
Phone: 720-415-0101