MEDICARE: TIANA MCKENZIE BROEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1033066378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA MCKENZIE BROEN

Provider Business Mailing Address
First Line	:	6035 COLONY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4863 N NEVADA AVE # 321
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3951
Country	:	US
Telephone Number	:	719-255-8002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ TIANA MCKENZIE BROEN ” Practice Location

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