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Contact Information

JENNIFER M DIVINE, MD
1260 DOCTOR'S LANE
FORT COLLINS, CO80524
 Phone: 970-286-2668
 Fax: 970-294-4954
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for JENNIFER M DIVINE · (Female)

NPI # 1063779072
Status Active
Credentials MD
Entity Individual
Enumeration date 04/15/2012
Last updated 07/19/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • CO License # DR.0058205
  • FL License # ME 131766
Hospital affiliation(s)
  • POUDRE VALLEY HOSPITAL - (Acute Care)
    1024 S LEMAY AVE
    FORT COLLINS, CO 80524
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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