Provider Demographics
NPI:1356742068
Name:COLBURN, ANDREA CHRISTINE (DNP, MSN, AGACNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:DNP, MSN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 SILVER SPUR CT
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1594
Mailing Address - Country:US
Mailing Address - Phone:832-622-5403
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1005
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8231
Practice Address - Country:US
Practice Address - Phone:281-888-0809
Practice Address - Fax:877-559-7682
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126513363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3799374K26Medicaid
TX379937YMCGMedicare PIN