Healthcare Provider Details

I. General information

NPI: 1679330906
Provider Name (Legal Business Name): TINA M CULLYFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 ACADEMY PARK LOOP
COLORADO SPRINGS CO
80910-3708
US

IV. Provider business mailing address

3797 S LINCOLN ST
ENGLEWOOD CO
80113-3621
US

V. Phone/Fax

Practice location:
  • Phone: 719-320-1054
  • Fax:
Mailing address:
  • Phone: 719-320-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN.1617494
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: