Provider Demographics
NPI:1477931913
Name:COLVIN, LINDA OTWAY (ACRNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:OTWAY
Last Name:COLVIN
Suffix:
Gender:F
Credentials:ACRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODLAND TER
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5807
Mailing Address - Country:US
Mailing Address - Phone:401-861-0707
Mailing Address - Fax:401-861-0707
Practice Address - Street 1:16 WOODLAND TER
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5807
Practice Address - Country:US
Practice Address - Phone:401-861-0707
Practice Address - Fax:401-861-0707
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00641363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care