Healthcare Provider Details

I. General information

NPI: 1184853715
Provider Name (Legal Business Name): TENLEY JOY ROEDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST STE 4101
FORT COLLINS CO
80525-1173
US

IV. Provider business mailing address

1136 E STUART ST STE 4101
FORT COLLINS CO
80525-1173
US

V. Phone/Fax

Practice location:
  • Phone: 970-833-1280
  • Fax: 949-437-2021
Mailing address:
  • Phone: 970-833-1280
  • Fax: 949-437-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP10022
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-10022
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0010022-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: