Provider Demographics
NPI:1316030893
Name:COLLI, AMY (CRNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COLLI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:TOMITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 ST PAUL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1033
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:830 5TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4219
Practice Address - Country:US
Practice Address - Phone:717-263-0550
Practice Address - Fax:717-263-8898
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007357363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics