Provider Demographics
NPI:1245892033
Name:MINTZ, COLLEEN (NP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1303
Mailing Address - Country:US
Mailing Address - Phone:970-477-4451
Mailing Address - Fax:970-477-7408
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-1303
Practice Address - Country:US
Practice Address - Phone:970-477-4451
Practice Address - Fax:970-477-7408
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994852-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.0188109OtherCO RN LICENSE