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General NPI Number Information
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NPI Number | 1174256465
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Entity Type | Organization
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Legal Business Name | PEDIATRIC & FAMILY PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 4740 FLINTRIDGE DR STE 220O
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4273
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Country | US
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Telephone | 719-407-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 4740 FLINTRIDGE DR STE 220O
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4273
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Country | US
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Telephone | 719-407-3312
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Fax |
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Authorized Official
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Title or Position | OWNER/ PMHNP-BC
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Name | TINA NANCE
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Credential | PMHNP-BC
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Telephone | 719-407-3312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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