Provider Demographics
NPI:1801177308
Name:COLSON, AMANDA JANE (APN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:COLSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 W MAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1344
Mailing Address - Country:US
Mailing Address - Phone:615-453-9492
Mailing Address - Fax:615-453-9498
Practice Address - Street 1:1670 W MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1344
Practice Address - Country:US
Practice Address - Phone:615-453-9492
Practice Address - Fax:615-453-9498
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN16043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily