MEDICARE: JESSICA MARIE COLOMBO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	193532	NC
2	367500000X	Certified Registered Nurse Anesthetist	ARNP9310689	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1861669806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE COLOMBO CRNA

Provider Business Mailing Address
First Line	:	3202 BOONE TRL
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2134
Country	:	US
Telephone Number	:	910-323-2477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 BOONE TRL
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2134
Country	:	US
Telephone Number	:	910-323-2477
Fax Number	:

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	11/04/2015

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