Healthcare Provider Details

I. General information

NPI: 1982407060
Provider Name (Legal Business Name): SUBLIME WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 ERIN PARK DR STE B-7
COLORADO SPRINGS CO
80918-3428
US

IV. Provider business mailing address

6020 ERIN PARK DR STE B-7
COLORADO SPRINGS CO
80918-3428
US

V. Phone/Fax

Practice location:
  • Phone: 530-632-2511
  • Fax: 719-888-1557
Mailing address:
  • Phone: 530-632-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA EBBS
Title or Position: PA-C/CEO AND MEDICAL PROVIDER
Credential: PA-C
Phone: 719-393-3001