Provider Demographics
NPI:1033764998
Name:KOLACKI, TERRA L (APRN)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:L
Last Name:KOLACKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N EOLA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9619
Mailing Address - Country:US
Mailing Address - Phone:630-692-5660
Mailing Address - Fax:630-692-5661
Practice Address - Street 1:444 N EOLA RD STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9619
Practice Address - Country:US
Practice Address - Phone:630-692-5660
Practice Address - Fax:630-692-5661
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001612363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily