Healthcare Provider Details

I. General information

NPI: 1316784853
Provider Name (Legal Business Name): COURTNEY LAINE HAWKINS ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-7250
  • Fax: 970-619-6094
Mailing address:
  • Phone: 970-203-7250
  • Fax: 970-619-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0999912-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0999912-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0999912-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: