Healthcare Provider Details

I. General information

NPI: 1982170585
Provider Name (Legal Business Name): CHRISTINA RENEE ELLIOTT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5799 STETSON HILLS BLVD STE 100
COLORADO SPRINGS CO
80917-4223
US

IV. Provider business mailing address

34 SANDRA LN
MANITOU SPRINGS CO
80829-2716
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-2273
  • Fax: 719-325-8971
Mailing address:
  • Phone: 719-685-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAPN.0993596-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0993596
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: