Provider Demographics
NPI:1316595937
Name:COLOMBO, ANTONIA (PA)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 FABLE ST
Mailing Address - Street 2:
Mailing Address - City:MERAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70075-2372
Mailing Address - Country:US
Mailing Address - Phone:504-722-4565
Mailing Address - Fax:
Practice Address - Street 1:2705 FABLE ST
Practice Address - Street 2:
Practice Address - City:MERAUX
Practice Address - State:LA
Practice Address - Zip Code:70075-2372
Practice Address - Country:US
Practice Address - Phone:504-722-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical