Provider Demographics
NPI:1356174908
Name:SIEDLARZ-TABOR, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SIEDLARZ-TABOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 CHAPEL HILLS DR STE 13
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1060
Mailing Address - Country:US
Mailing Address - Phone:719-474-3031
Mailing Address - Fax:850-202-7478
Practice Address - Street 1:595 CHAPEL HILLS DR STE 13
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1060
Practice Address - Country:US
Practice Address - Phone:719-474-3031
Practice Address - Fax:850-202-7478
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000093-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health