MEDICARE: MRS. BIANCA COLMENARES NP

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
1	363LF0000X	Family Nurse Practitioner	0024185763	VA

General Provider Information

NPI Number	:	1457063323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BIANCA COLMENARES NP

Provider Business Mailing Address
First Line	:	10024 JACKSONS WAY
Second Line	:
City	:	PORT REPUBLIC
State	:	VA
Zip	:	24471-2337
Country	:	US
Telephone Number	:	904-303-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	10024 JACKSONS WAY
Second Line	:
City	:	PORT REPUBLIC
State	:	VA
Zip	:	24471-2337
Country	:	US
Telephone Number	:	540-215-0082
Fax Number	:	540-930-0751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	03/15/2024

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