Provider Demographics
NPI:1215667936
Name:TRIFECTA FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:TRIFECTA FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:719-468-1569
Mailing Address - Street 1:805 EAGLERIDGE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2194
Mailing Address - Country:US
Mailing Address - Phone:719-627-4287
Mailing Address - Fax:719-220-7658
Practice Address - Street 1:805 EAGLERIDGE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2194
Practice Address - Country:US
Practice Address - Phone:719-627-4287
Practice Address - Fax:719-220-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty