Provider Demographics
NPI:1972988962
Name:DRISCOLL, COLLEEN MICHELE (NP-C)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MICHELE
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MICHELE
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1299 INDUSTRIAL PKWY N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6367
Mailing Address - Country:US
Mailing Address - Phone:330-225-6468
Mailing Address - Fax:330-225-6534
Practice Address - Street 1:1299 INDUSTRIAL PKWY N
Practice Address - Street 2:SUITE 110
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6367
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:330-225-6534
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17716-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily