Healthcare Provider Details

I. General information

NPI: 1851255426
Provider Name (Legal Business Name): DEYANYS SERRA COLINA AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11202 PROFESSIONAL PARK DR APT 102
LOUISVILLE KY
40291-4486
US

IV. Provider business mailing address

11202 PROFESSIONAL PARK DR APT 102
LOUISVILLE KY
40291-4486
US

V. Phone/Fax

Practice location:
  • Phone: 502-299-7812
  • Fax:
Mailing address:
  • Phone: 502-299-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4049693
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: