Provider Demographics
NPI:1205308913
Name:COLUCCI, HOLLIE ANN
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:ANN
Last Name:COLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5807
Mailing Address - Country:US
Mailing Address - Phone:401-234-6685
Mailing Address - Fax:401-250-9703
Practice Address - Street 1:215 LEGRIS AVE
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2937
Practice Address - Country:US
Practice Address - Phone:401-234-6685
Practice Address - Fax:401-250-9703
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily