Provider Demographics
NPI:1770304073
Name:COLONIAL AESTHETICS & WELLNESS
Entity type:Organization
Organization Name:COLONIAL AESTHETICS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:STROUD
Authorized Official - Last Name:PTACHICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:757-532-3563
Mailing Address - Street 1:1313 JAMESTOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3362
Mailing Address - Country:US
Mailing Address - Phone:757-585-4162
Mailing Address - Fax:
Practice Address - Street 1:1313 JAMESTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3362
Practice Address - Country:US
Practice Address - Phone:757-585-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty