Healthcare Provider Details

I. General information

NPI: 1033066378
Provider Name (Legal Business Name): TIANA MCKENZIE BROEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 N NEVADA AVE # 321
COLORADO SPRINGS CO
80918-3951
US

IV. Provider business mailing address

6035 COLONY CIR
COLORADO SPRINGS CO
80919-2212
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: