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General NPI Number Information
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NPI Number | 1457240301
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Entity Type | Individual
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Provider Name | TARYN ATALYA MACK DNP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 900 INDIANA AVE STE C
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City | PUEBLO
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State | CO
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Zip | 81004-3767
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Country | US
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Telephone | 719-568-8661
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 PONY TRACKS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1402
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Country | US
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Telephone | 402-650-6498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1679998
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License Number State | CO
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