Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Divine Dermatology and Surgical Institute, PLLC

Organization Medical Specialty Clinic/Center · NPI 1215460290

Divine Dermatology and Surgical Institute, PLLC is a Medical Specialty Clinic/Center in Fort Collins, Colorado. Licensed in Colorado. Registered with an NPI since 2017.

Licensed in
CO
In the registry since
2017
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1260 Doctors Ln
Fort Collins, CO 80524-4038
Phone: (813) 765-8453
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Specialty Clinic/Center (primary) Taxonomy 261QM2500X · Licence DR.0058205 (CO)

Record details

NPI number1215460290
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Divine — Owner · (970) 388-2850
NPI enumeratedApril 6, 2017
Last updated in NPPESSeptember 10, 2024
Certification dateSeptember 10, 2024
Mailing address1260 Doctors Ln Ste A, Fort Collins, CO 80524-4072

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