MEDICARE: TIMOTHY CONSTANT APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0999042-NP	CO

General Provider Information

NPI Number	:	1164276747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY CONSTANT APN

Provider Business Mailing Address
First Line	:	1909 HARMONY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3443
Country	:	US
Telephone Number	:	970-402-7074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 MIDPOINT DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4419
Country	:	US
Telephone Number	:	970-498-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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