Provider Demographics
NPI:1679330906
Name:CULLYFORD, TINA M (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CULLYFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3621
Mailing Address - Country:US
Mailing Address - Phone:719-320-1054
Mailing Address - Fax:
Practice Address - Street 1:1250 ACADEMY PARK LOOP
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3708
Practice Address - Country:US
Practice Address - Phone:719-320-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1617494163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator