Provider Demographics
NPI:1114518693
Name:PUTZ, TRACEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:PUTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2828
Mailing Address - Country:US
Mailing Address - Phone:719-635-3764
Mailing Address - Fax:719-635-7593
Practice Address - Street 1:1605 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2828
Practice Address - Country:US
Practice Address - Phone:719-635-3764
Practice Address - Fax:719-635-7593
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2020117515207Q00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily