Provider Demographics
NPI:1518319094
Name:STAVROS, ANNE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:M
Last Name:STAVROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-225-5000
Mailing Address - Fax:970-378-8088
Practice Address - Street 1:313 W DRAKE ROAD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-225-5000
Practice Address - Fax:970-356-6928
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AM0700X
CO5582363A00000X
COPA0005582363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0005582OtherDEPT OF REGULATORY AGENCIES DORA