Healthcare Provider Details

I. General information

NPI: 1790032787
Provider Name (Legal Business Name): VITINA MARIE COSSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S CAMINO DEL RIO
DURANGO CO
81303-6886
US

IV. Provider business mailing address

6405 S 3000 E STE 201
SALT LAKE CITY UT
84121-6990
US

V. Phone/Fax

Practice location:
  • Phone: 970-659-9850
  • Fax: 970-579-6750
Mailing address:
  • Phone: 801-266-3113
  • Fax: 801-266-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1645328
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14206224-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02998
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992885-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: