Provider Demographics
NPI:1518237767
Name:COLTON-SPINA, JILL ANN (NP, RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:COLTON-SPINA
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:COLTON-SPINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:548 MARKET ST
Mailing Address - Street 2:DONE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 TECHNOLOGY PARK, STE 109
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN38344163W00000X
MECNP111116363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400170334Medicare PIN