Healthcare Provider Details

I. General information

NPI: 1669734158
Provider Name (Legal Business Name): SARAH R COLSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

IV. Provider business mailing address

5807 MCDONALD RD
HAHIRA GA
31632-3627
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-8989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNCO-000001
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: