Healthcare Provider Details

I. General information

NPI: 1164263489
Provider Name (Legal Business Name): COLBY BETH MICKARTZ AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRIS CT STE 201
MONTEREY CA
93940-5750
US

IV. Provider business mailing address

5 HARRIS CT STE 201
MONTEREY CA
93940-5750
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP241192
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP241192
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: