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NPI Code Detail

MEDICARE: MRS. KRISTINA DANIELA MCCOLGAN PA-C

MEDICARE: MRS. KRISTINA DANIELA MCCOLGAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA9111580FL
2363A00000XPhysician AssistantPA9111580FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083197420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTINA DANIELA MCCOLGAN PA-C
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-3292
Fax Number : 239-343-3695
Provider Business Practice Location Address
First Line : 2776 CLEVELAND AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-5864
Country : US
Telephone Number : 239-343-3292
Fax Number : 239-343-3695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 12/10/2025

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Directions to “ MRS. KRISTINA DANIELA MCCOLGAN PA-C” Practice Location

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