Provider Demographics
NPI:1437570827
Name:COLELLA, KAITLIN THERESA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:THERESA
Last Name:COLELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 107
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:321-842-9000
Mailing Address - Fax:321-843-6326
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 107
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:321-842-9000
Practice Address - Fax:321-843-6326
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9107532363AM0700X
FLPA9107532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical