Provider Demographics
NPI:1235205071
Name:KNAPP-COLSTON, BARBARA ANN (ANP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:KNAPP-COLSTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30062 RUNNING DEER LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2023
Mailing Address - Country:US
Mailing Address - Phone:949-495-9125
Mailing Address - Fax:949-495-6985
Practice Address - Street 1:22921 TRITON WAY
Practice Address - Street 2:SUITE 125
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1236
Practice Address - Country:US
Practice Address - Phone:949-366-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA339965363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP4691Medicare ID - Type Unspecified
CAP10964Medicare UPIN