Provider Demographics
NPI:1841261997
Name:COLBERT, JON CLYDE (FNP)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:CLYDE
Last Name:COLBERT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4791 E PALM CANYON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5232
Mailing Address - Country:US
Mailing Address - Phone:760-834-7950
Mailing Address - Fax:760-834-7951
Practice Address - Street 1:4791 E PALM CANYON DR STE 100
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-5232
Practice Address - Country:US
Practice Address - Phone:760-834-7950
Practice Address - Fax:760-834-7951
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12914363LF0000X
CA556243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily