Healthcare Provider Details

I. General information

NPI: 1235727587
Provider Name (Legal Business Name): JILLIAN COLBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 GREAT RD
BEDFORD MA
01730-2725
US

IV. Provider business mailing address

41 PENNYBROOK RD
LYNN MA
01905-1012
US

V. Phone/Fax

Practice location:
  • Phone: 617-605-8795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2302562
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: