NPIMap

Individual provider Active NPI

Leasa Marie Garrett, FNP

  • Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1609552603
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0998811 Issued in CO
Practice address
1212 E Elizabeth St
Fort Collins, CO 80524-4007
Phone
(970) 482-2791
NPI assigned
Jun 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0998811 CO Primary

Addresses

Primary practice location

1212 E Elizabeth St
Fort Collins, CO 80524-4007

Mailing address

1212 E Elizabeth St
Fort Collins, CO 80524-4007
Phone (970) 482-2791

Other names 1

  • Leasa Marie Nieuwsma Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230906001763 CO Practitioner - Nurse Practitioner 0042673238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
The Family Clinic of Fort CollinsGroup PAC ID 5890684179, 8 clinicians

Practice addresses (Care Compare)

1212 E Elizabeth St
Fort Collins, CO 80524-4007
Phone (970) 482-2791

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0998811COMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Family Clinic of Fort Collins CurrentSince Sep 1, 2023 Accepting new patients
Julie Devita-Bailey, D.O., P.C. PastSince Jun 25, 2023 Accepting new patients

Locations

1212 E Elizabeth St
Fort Collins, CO 80524
Phone (970) 482-2791

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1609552603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 E ELIZABETH ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244007",
            "telephone_number": "970-482-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 E ELIZABETH ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244007",
            "telephone_number": "970-482-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRETT",
        "first_name": "LEASA",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "0998811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEASA",
            "last_name": "NIEUWSMA",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.