Healthcare Provider Details

I. General information

NPI: 1124933882
Provider Name (Legal Business Name): LAURA TULLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD STE 310
COLORADO SPRINGS CO
80920-3947
US

IV. Provider business mailing address

7730 MANSTON DR
COLORADO SPRINGS CO
80920-8073
US

V. Phone/Fax

Practice location:
  • Phone: 719-726-6573
  • Fax:
Mailing address:
  • Phone: 719-726-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1002292-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: