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General NPI Number Information
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NPI Number | 1316714520
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS IV HYDRATION AND INJECTION WELLNESS CLINIC
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 9609 WATERBURY DR
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City | PEYTON
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State | CO
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Zip | 80831-6831
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Country | US
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Telephone | 719-352-8362
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Fax |
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Provider Business Mailing Address
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Address Line | 9609 WATERBURY DR
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City | PEYTON
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State | CO
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Zip | 80831-6831
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Country | US
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Telephone | 719-352-8362
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | TAMMIE L HILLIARD
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Credential | FNP
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Telephone | 719-352-8362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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