Provider Demographics
NPI:1982065462
Name:HIDALGO, COLIN ROSS (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:ROSS
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122165
Mailing Address - Street 2:DEPT 2165
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2165
Mailing Address - Country:US
Mailing Address - Phone:337-494-4900
Mailing Address - Fax:337-494-4936
Practice Address - Street 1:1717 OAK PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-4900
Practice Address - Fax:337-494-4936
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP08659OtherFNP-C LICNESE