Provider Demographics
NPI:1356990550
Name:NORRIS, COLBY (PA)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 SWEET RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4691
Mailing Address - Country:US
Mailing Address - Phone:727-688-2394
Mailing Address - Fax:
Practice Address - Street 1:1838 JACLIF CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4400
Practice Address - Country:US
Practice Address - Phone:850-889-1234
Practice Address - Fax:850-273-6495
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112824363A00000X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program