Provider Demographics
NPI:1477202760
Name:GERLACH, COLLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GERLACH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:3 RAVDIN BLDG STE F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:221-566-2320
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:3 RAVDIN BLDG STE F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:221-566-2320
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025264363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care