Healthcare Provider Details

I. General information

NPI: 1992086839
Provider Name (Legal Business Name): COLLIN MICHAEL ZANDER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 E ELIZABETH ST STE C
FORT COLLINS CO
80524-3952
US

IV. Provider business mailing address

1319 TUCKAWAY CT
FORT COLLINS CO
80525-2885
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-9193
  • Fax:
Mailing address:
  • Phone: 970-310-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991049
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75474
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77748
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number77748
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0991049
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: