Healthcare Provider Details

I. General information

NPI: 1124941828
Provider Name (Legal Business Name): TIFFANY PRIDMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 BERGEN PEAK DR
EVERGREEN CO
80439-2200
US

IV. Provider business mailing address

3081 BERGEN PEAK DR
EVERGREEN CO
80439-2200
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-6400
  • Fax: 303-679-1372
Mailing address:
  • Phone: 303-674-6400
  • Fax: 303-679-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09933562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: