Healthcare Provider Details

I. General information

NPI: 1447684360
Provider Name (Legal Business Name): PATRICIA ANNE COLVIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73-5618 MAIAU ST SUITE A204
KAILUA KONA HI
96740-2616
US

IV. Provider business mailing address

73-5618 MAIAU ST SUITE A204
KAILUA KONA HI
96740-2616
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-1146
  • Fax: 808-329-1120
Mailing address:
  • Phone: 808-329-1146
  • Fax: 808-329-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD260
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: