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NPI Code Detail

MEDICARE: LISA LEILANI VAN TINE CPNP,CNS

MEDICARE: LISA LEILANI VAN TINE CPNP,CNS
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
1163W00000XRegistered NurseRN.0127666CO
2363L00000XNurse PractitionerRXN.0006301-NPCO
3363LP0200XPediatric Nurse PractitionerAPN.0004136-NPCO

General Provider Information

NPI Number : 1508973074
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LEILANI VAN TINE CPNP,CNS
Provider Business Mailing Address
First Line : 3701 S BROADWAY
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80113-3611
Country : US
Telephone Number : 303-761-1977
Fax Number : 303-761-2787
Provider Business Practice Location Address
First Line : 3292 PEORIA ST
Second Line :
City : AURORA
State : CO
Zip : 80010-1517
Country : US
Telephone Number : 303-343-6130
Fax Number : 303-344-0664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 01/16/2019

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