Provider Demographics
NPI:1881672079
Name:BLACKINGTON, COLETTE COLLINS (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:COLLINS
Last Name:BLACKINGTON
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 MYRTLE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1043
Mailing Address - Country:US
Mailing Address - Phone:518-584-7671
Mailing Address - Fax:518-584-0076
Practice Address - Street 1:35 MYRTLE STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1043
Practice Address - Country:US
Practice Address - Phone:518-584-7671
Practice Address - Fax:518-584-0076
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30801Medicare UPIN