Healthcare Provider Details

I. General information

NPI: 1720690399
Provider Name (Legal Business Name): NELLI FARIDOVNA MURTAZINA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NELLI FARIDOVNA SAFFOLD ARNP

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WOODMOOR DR STE 102
MONUMENT CO
80132-9083
US

IV. Provider business mailing address

2335 CORALBELL GRV APT 102
COLORADO SPRINGS CO
80910-1364
US

V. Phone/Fax

Practice location:
  • Phone: 719-622-6522
  • Fax:
Mailing address:
  • Phone: 407-802-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11009505
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10191147
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: