Healthcare Provider Details

I. General information

NPI: 1811240021
Provider Name (Legal Business Name): NEELOFER BAIG CLARK L AC RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PENNOCK PL STE 121
FORT COLLINS CO
80524-3250
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8980
  • Fax: 970-495-8988
Mailing address:
  • Phone: 970-970-2421
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164885
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1443
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998347
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: