Healthcare Provider Details

I. General information

NPI: 1346361599
Provider Name (Legal Business Name): SAMANTHA ELIZABETH DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 SNOW MESA DR STE 140
FORT COLLINS CO
80528-8614
US

IV. Provider business mailing address

6004 TAHOE CT
LOVELAND CO
80538-1843
US

V. Phone/Fax

Practice location:
  • Phone: 970-225-5000
  • Fax:
Mailing address:
  • Phone: 559-908-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990952-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0990952-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number16533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: