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General NPI Number Information
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NPI Number | 1982407060
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Entity Type | Organization
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Legal Business Name | SUBLIME WELLNESS, INC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 6020 ERIN PARK DR STE B-7
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3428
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Country | US
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Telephone | 530-632-2511
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Fax | 719-888-1557
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Provider Business Mailing Address
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Address Line | 6020 ERIN PARK DR STE B-7
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3428
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Country | US
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Telephone | 530-632-2511
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Fax |
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Authorized Official
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Title or Position | PA-C/CEO AND MEDICAL PROVIDER
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Name | TARA EBBS
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Credential | PA-C
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Telephone | 719-393-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 364SH1100X
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Taxonomy Name | Holistic Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 364SN0800X
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Taxonomy Name | Neuroscience Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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