Provider Demographics
NPI:1467886069
Name:PATINO, SUSAN NICOLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NICOLE
Last Name:PATINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:169 INVERNESS DR W STE 400
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5072
Mailing Address - Country:US
Mailing Address - Phone:719-313-6046
Mailing Address - Fax:
Practice Address - Street 1:729 E SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-3512
Practice Address - Country:US
Practice Address - Phone:719-547-9119
Practice Address - Fax:719-547-7555
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0990798NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily