Organization
IDEAL FAMILY MEDICINE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JADE BRYANT FNP-BC (OWNER)
(719) 582-1489
Entity
Organization
Contact information
Practice address
1910 LAKE AVE, PUEBLO, CO 81004-3322
(719) 582-1489
(719) 434-9807
Mailing address
19 E ABARR DR # 200, PUEBLO, CO 81007-5436
(719) 582-1489
(719) 434-9807
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0992962
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154861995
—
CO
Enumeration date
04/11/2017
Last updated
03/04/2024
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