Provider Demographics
NPI:1679871313
Name:COLON, ALICIA MARIE (CST/ FA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:COLON
Suffix:
Gender:F
Credentials:CST/ FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3030
Mailing Address - Country:US
Mailing Address - Phone:850-499-1069
Mailing Address - Fax:
Practice Address - Street 1:1025 BEAL PKWY NW
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1446
Practice Address - Country:US
Practice Address - Phone:850-862-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant