Healthcare Provider Details

I. General information

NPI: 1316714520
Provider Name (Legal Business Name): COLORADO SPRINGS IV HYDRATION AND INJECTION WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 WATERBURY DR
PEYTON CO
80831-6831
US

IV. Provider business mailing address

9609 WATERBURY DR
PEYTON CO
80831-6831
US

V. Phone/Fax

Practice location:
  • Phone: 719-352-8362
  • Fax:
Mailing address:
  • Phone: 719-352-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE L HILLIARD
Title or Position: FNP
Credential: FNP
Phone: 719-352-8362