Provider Demographics
NPI:1508086158
Name:COLBERT, THERESA MARIE (APRN, DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:APRN, DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 E BROAD ST
Mailing Address - Street 2:MOUNT CARMEL EAST HOSPITAL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1502
Mailing Address - Country:US
Mailing Address - Phone:614-234-7505
Mailing Address - Fax:
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-309-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09024OtherLICENSE
OHCONP24051Medicare PIN