Provider Demographics
NPI:1164010641
Name:COLGATE, EMILY RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:COLGATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SHANNON LAKES CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3650
Mailing Address - Country:US
Mailing Address - Phone:321-442-4554
Mailing Address - Fax:
Practice Address - Street 1:6685 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4206
Practice Address - Country:US
Practice Address - Phone:352-333-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant