Provider Demographics
NPI:1396547378
Name:COLAS, AGATHE (NP)
Entity type:Individual
Prefix:
First Name:AGATHE
Middle Name:
Last Name:COLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 HENDRIX ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2017
Mailing Address - Country:US
Mailing Address - Phone:646-402-3319
Mailing Address - Fax:
Practice Address - Street 1:647 HENDRIX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2017
Practice Address - Country:US
Practice Address - Phone:646-402-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR25562500363LP0808X
PASP031306363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health