Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Divine Dermatology and Surgical Institute, PLLC

Organization Dermatology Physician · NPI 1962164269

Divine Dermatology and Surgical Institute, PLLC provides Dermatology Physician services in Longmont, Colorado. Registered with an NPI since 2021.

In the registry since
2021
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

1715 Iron Horse Dr Ste 104
Longmont, CO 80501-9756
Phone: (970) 286-2668
Fax: (970) 294-4954
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1962164269
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationDivine Dermatology and Surgical Institue, PLLC
Authorized official Jennifer Divine — Owner · (970) 286-2668
Other names Divine Dermatology
NPI enumeratedOctober 13, 2021
Last updated in NPPESOctober 13, 2021
Certification dateOctober 13, 2021
Mailing address1260 Doctors Ln Ste A, Fort Collins, CO 80524-4072

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