Provider Demographics
NPI:1497596480
Name:PAGOADA, COLLEEN ROSE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ROSE
Last Name:PAGOADA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 PRETTY WAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-3089
Mailing Address - Country:US
Mailing Address - Phone:985-774-1497
Mailing Address - Fax:
Practice Address - Street 1:2003 WILSON AVE UNIT A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4532
Practice Address - Country:US
Practice Address - Phone:850-784-9991
Practice Address - Fax:850-163-8361
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110329712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry