Provider Demographics
NPI:1083146336
Name:COLLA, JOSHUA ADAM (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ADAM
Last Name:COLLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-241-2370
Mailing Address - Fax:
Practice Address - Street 1:4805 MONTGOMERY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2198
Practice Address - Country:US
Practice Address - Phone:513-241-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020167363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH516620Medicare PIN