Provider Demographics
NPI:1306381991
Name:COLON, JESSENIA
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT.JARDINES DE COAMO F23
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00769
Mailing Address - Country:UM
Mailing Address - Phone:787-426-8752
Mailing Address - Fax:
Practice Address - Street 1:F23 EXT JARDINES DE COAMO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-426-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72519163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health