Provider Demographics
NPI:1992086839
Name:ZANDER, COLLIN MICHAEL (APRN)
Entity type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:MICHAEL
Last Name:ZANDER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 TUCKAWAY CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2885
Mailing Address - Country:US
Mailing Address - Phone:970-310-4389
Mailing Address - Fax:
Practice Address - Street 1:1040 E ELIZABETH ST STE C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3952
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991049363LF0000X, 363LP0808X
KS75474363L00000X
NM77748363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1598135451Medicaid