MEDICARE: ELIZABETH ANNE PORTER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	1001003	CO

General Provider Information

NPI Number	:	1275411217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE PORTER NP

Provider Business Mailing Address
First Line	:	2854 DUNBAR AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2266
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2854 DUNBAR AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2266
Country	:	US
Telephone Number	:	970-818-6271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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