Provider Demographics
NPI:1376950089
Name:COLLETTE, ZOE NICOLE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ZOE
Middle Name:NICOLE
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:NICOLE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:STE 525
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-661-7888
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:STE 525
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3519
Practice Address - Country:US
Practice Address - Phone:713-661-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711817163WC0200X
TXAP126270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX426719701Medicaid