DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
NPI 1104452804
Dermatology in Loveland, CO

Active since March 14, 2020CLIA Certified · 2 labs
1327 EAGLE DR, LOVELAND, CO 80537(970) 286-2668 Get Directions Write a Review

NPPES record last updated: March 14, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Divine Dermatology And Surgical Institute, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC (NPI 1104452804) is a healthcare organization registered as a dermatology in Loveland, Colorado and active in the NPI registry since March 2020. The organization holds 2 active CLIA laboratory certificates and lists Jennifer Michelle Divine, Owner, as its authorized official.

NPPES Registry Identity

NPI1104452804
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Location Address1327 EAGLE DRLoveland, CO 80537-8059
Mailing Address1327 Eagle DrLoveland, CO 80537-8059
Organization SubpartYes
Authorized OfficialJennifer Michelle DivineOwner · (970) 286-2668
Enumeration DateMarch 14, 2020
NPPES CertifiedMarch 14, 2020
NPI 1104452804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
1327 EAGLE DR, Loveland, CO 80537

Other Names 1

Other NameDivine Dermatology And Surgical Institute

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 06D2174753

Divine Dermatology And Surgical Institute · Loveland, CO
Active · expires Oct 7, 2026
CLIA Number06D2174753
Laboratory TypePhysician Office
Certificate Effective DateOctober 8, 2024
Certificate Expiration DateOctober 7, 2026
Laboratory DirectorDr. Jennifer M. Divine
Laboratory Phone(970) 286-2668
Laboratory LocationDivine Dermatology And Surgical Institute1327 Eagle Drive, Loveland, CO 80537
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 06D2264489

Divine Dermotology And Surgical Institute · Longmont, CO
Active · expires Jul 13, 2028
CLIA Number06D2264489
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2026
Certificate Expiration DateJuly 13, 2028
Laboratory DirectorDr. Jennifer M. Divine
Laboratory Phone(970) 286-2668
Laboratory LocationDivine Dermotology And Surgical Institute1715 Iron Horse Drive Suite 104, Longmont, CO 80501
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Compliance 06D2130927

Divine Dermatology And Surgical Institute, PLLC · Fort Collins, CO
Expired · Jul 31, 2026
CLIA Number06D2130927
Laboratory TypePhysician Office
Certificate Effective DateFebruary 6, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorJennifer M. Divine
Laboratory Phone(970) 286-2668
Laboratory LocationDivine Dermatology And Surgical Institute, PLLC1260 Doctors Lane, Ste A, Fort Collins, CO 80524
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
1327 EAGLE DR
LOVELAND, CO 80537
Physician Assistant
1327 EAGLE DR
LOVELAND, CO 80537

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Divine Dermatology And Surgical Institute, PLLC's NPI number?

The NPI number for Divine Dermatology And Surgical Institute, PLLC is 1104452804. It was assigned to this organization in the NPPES registry on March 14, 2020. The provider is also known as Divine Dermatology and Surgical Institute.

Where is Divine Dermatology And Surgical Institute, PLLC located?

Divine Dermatology And Surgical Institute, PLLC is located at 1327 Eagle Dr, Loveland, CO 80537. The listed phone number is (970) 286-2668.

What is Divine Dermatology And Surgical Institute, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Divine Dermatology And Surgical Institute, PLLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Divine Dermatology And Surgical Institute, PLLC was last updated on March 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.