Healthcare Provider Details

I. General information

NPI: 1134063647
Provider Name (Legal Business Name): LARISSA NELLIE BROTHERS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 ZIEGLER RD
FORT COLLINS CO
80528-9007
US

IV. Provider business mailing address

4483 BARROW LN
TIMNATH CO
80547-5842
US

V. Phone/Fax

Practice location:
  • Phone: 970-591-9415
  • Fax:
Mailing address:
  • Phone: 970-290-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001876-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: