Provider Demographics
NPI:1710518907
Name:COLACINO, GEOFF (RN)
Entity Type:Individual
Prefix:MR
First Name:GEOFF
Middle Name:
Last Name:COLACINO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 MIA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4247
Mailing Address - Country:US
Mailing Address - Phone:210-812-1743
Mailing Address - Fax:
Practice Address - Street 1:15420 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1106
Practice Address - Country:US
Practice Address - Phone:210-812-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220375164X00000X
TX796700163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No164X00000XNursing Service ProvidersLicensed Vocational Nurse