Provider Demographics
NPI:1225581572
Name:COLVIN, CARLA ANN (NP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:COLVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:300 JUBILEE DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4068
Mailing Address - Country:US
Mailing Address - Phone:866-898-8125
Mailing Address - Fax:888-316-0982
Practice Address - Street 1:75 STATE ST FL 26
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1827
Practice Address - Country:US
Practice Address - Phone:617-204-3500
Practice Address - Fax:617-428-4917
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ254714364SF0001X
AR120900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health