Healthcare Provider Details

I. General information

NPI: 1518237767
Provider Name (Legal Business Name): JILL ANN COLTON-SPINA NP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN COLTON-SPINA PMHNP

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 05/10/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 TECHNOLOGY PARK, STE 109
LAKE MARY FL
32746
US

IV. Provider business mailing address

548 MARKET ST DONE
SAN FRANCISCO CA
94104
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP111116
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN38344
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: