Organization
PEDIATRIC & FAMILY PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA NANCE PMHNP-BC (OWNER/ PMHNP-BC)
(719) 407-3312
Entity
Organization
Contact information
Practice address
4740 FLINTRIDGE DR STE 220O, COLORADO SPRINGS, CO 80918-4273
(719) 407-3312
Mailing address
4740 FLINTRIDGE DR STE 220O, COLORADO SPRINGS, CO 80918-4273
(719) 407-3312
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06D2265433
CLIA
CO
05
—
9000176721
—
CO
Enumeration date
07/05/2022
Last updated
12/21/2023
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