MEDICARE: STEPHANIE ANNE MARTIN NP

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	363LA2100X	Acute Care Nurse Practitioner	0994769	CO
2	363LA2200X	Adult Health Nurse Practitioner	APN.0994769-NP	CO

General Provider Information

NPI Number	:	1912568866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANNE MARTIN NP

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 4202
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1193
Country	:	US
Telephone Number	:	970-344-8474
Fax Number	:	949-864-3755

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 4202
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1193
Country	:	US
Telephone Number	:	970-344-8474
Fax Number	:	949-864-3755

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

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	09/02/2025

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