Healthcare Provider Details

I. General information

NPI: 1477352490
Provider Name (Legal Business Name): AUDREANNA LOUISE CRISTO AG-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N ACADEMY BLVD STE 200
COLORADO SPRINGS CO
80917-5332
US

IV. Provider business mailing address

513 COWBOY KNL
CIBOLO TX
78108-0538
US

V. Phone/Fax

Practice location:
  • Phone: 901-496-5131
  • Fax:
Mailing address:
  • Phone: 901-496-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberC-APN.0103241-C-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: