Provider Demographics
NPI:1568100717
Name:COLICCHIO, PAIGE ANN (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:ANN
Last Name:COLICCHIO
Suffix:
Gender:F
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 1:40 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5951
Mailing Address - Country:US
Mailing Address - Phone:774-280-6821
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR STE 4350
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6518
Practice Address - Country:US
Practice Address - Phone:774-280-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner