Provider Demographics
NPI:1063030914
Name:COLON, FREDERICK BON MAQUITO (AGPCNP)
Entity Type:Individual
Prefix:
First Name:FREDERICK BON
Middle Name:MAQUITO
Last Name:COLON
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CORNERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03276-4004
Mailing Address - Country:US
Mailing Address - Phone:603-286-4134
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST # 444
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHAG06200112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner