Provider Demographics
NPI:1649835968
Name:COLBY, REA ANASTACIO (CRNP)
Entity type:Individual
Prefix:
First Name:REA
Middle Name:ANASTACIO
Last Name:COLBY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK CENTER CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4221
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:
Practice Address - Street 1:130 HOSPITAL RD STE 101
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4029
Practice Address - Country:US
Practice Address - Phone:410-571-2946
Practice Address - Fax:410-571-2947
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily