Healthcare Provider Details

I. General information

NPI: 1114518693
Provider Name (Legal Business Name): TRACEY PUTZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 S CAREFREE CIR STE F
COLORADO SPRINGS CO
80917-3053
US

IV. Provider business mailing address

3910 S CAREFREE CIR STE F
COLORADO SPRINGS CO
80917-3053
US

V. Phone/Fax

Practice location:
  • Phone: 719-463-7725
  • Fax: 719-888-1793
Mailing address:
  • Phone: 719-463-7725
  • Fax: 719-888-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020117515
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020117515
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2020117515
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: