Provider Demographics
NPI:1790016012
Name:COLASANTE CLINIC,PA
Entity Type:Organization
Organization Name:COLASANTE CLINIC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-3220
Mailing Address - Street 1:810 NW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4012
Mailing Address - Country:US
Mailing Address - Phone:352-371-3220
Mailing Address - Fax:352-371-3320
Practice Address - Street 1:810 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4012
Practice Address - Country:US
Practice Address - Phone:352-371-3220
Practice Address - Fax:352-371-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6367430002Medicare NSC