Healthcare Provider Details

I. General information

NPI: 1255912788
Provider Name (Legal Business Name): CHRISTINA MARIE LYTLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E FONTANERO ST STE 308
COLORADO SPRINGS CO
80907-7526
US

IV. Provider business mailing address

1074 GOLDEN PINE LN
MONUMENT CO
80132-9347
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-4200
  • Fax: 719-442-6595
Mailing address:
  • Phone: 731-618-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1678467
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29773
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRXN.0106175-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997152-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: