# DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215460290
- **Authorized official:** DR. JENNIFER DIVINE M.D. (OWNER)
- **Authorized official phone:** (970) 388-2850

## Contact information

- **Practice address:** 1260 DOCTORS LN, FORT COLLINS, CO 80524-4038
- **Practice address phone:** (813) 765-8453
- **Mailing address:** 1260 DOCTORS LN STE A, FORT COLLINS, CO 80524-4072
- **Mailing address phone:** (970) 286-2668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | DR.0058205 | CO | Yes |

## Other

- **Enumeration date:** 04/06/2017
- **Last updated:** 09/10/2024