Provider Demographics
NPI:1659471134
Name:SCHRAMM, COLLEEN MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:SCHRAMM
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 AUGUSTA NATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4230
Mailing Address - Country:US
Mailing Address - Phone:407-542-4513
Mailing Address - Fax:407-542-4513
Practice Address - Street 1:1358 AUGUSTA NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4230
Practice Address - Country:US
Practice Address - Phone:407-542-4513
Practice Address - Fax:407-542-4513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1127872363L00000X
IN28124266A363L00000X
AKR 19422363LF0000X
AK576363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK550499Medicare UPIN