Healthcare Provider Details

I. General information

NPI: 1093699357
Provider Name (Legal Business Name): AVALANCHE FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 AUSTIN BLUFFS PKWY STE 306
COLORADO SPRINGS CO
80918-5755
US

IV. Provider business mailing address

3505 AUSTIN BLUFFS PKWY STE 306
COLORADO SPRINGS CO
80918-5755
US

V. Phone/Fax

Practice location:
  • Phone: 719-430-0620
  • Fax:
Mailing address:
  • Phone: 719-430-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA PROULX
Title or Position: FNP-BC/ OWNER
Credential: FNP-BC
Phone: 719-430-0620