Provider Demographics
NPI:1477824340
Name:COLOTTA, MICHAEL CRAIG (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CRAIG
Last Name:COLOTTA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 COUNTY ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:TX
Mailing Address - Zip Code:75946-6757
Mailing Address - Country:US
Mailing Address - Phone:936-556-0101
Mailing Address - Fax:
Practice Address - Street 1:105 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-3133
Practice Address - Country:US
Practice Address - Phone:903-392-8259
Practice Address - Fax:903-657-1674
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily