Provider Demographics
NPI:1891170783
Name:KOLK, ADRIENNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:KOLK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVE # DA1220
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-582-9469
Mailing Address - Fax:617-632-5370
Practice Address - Street 1:450 BROOKLINE AVE # DA1220
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-582-9469
Practice Address - Fax:617-632-5370
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily