Provider Demographics
NPI:1780702191
Name:HIBBERT, COLLEEN MARIE (RN,MSN,PNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:HIBBERT
Suffix:
Gender:
Credentials:RN,MSN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5772 WINDWARD CT NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9027
Mailing Address - Country:US
Mailing Address - Phone:919-749-4158
Mailing Address - Fax:
Practice Address - Street 1:1040 VINEHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2438
Practice Address - Country:US
Practice Address - Phone:704-784-1010
Practice Address - Fax:704-784-1013
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20060225363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics