Healthcare Provider Details

I. General information

NPI: 1932642402
Provider Name (Legal Business Name): TERI COLQUETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

IV. Provider business mailing address

507 CYPRESS ST
WEBB AL
36376-6371
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-4252
  • Fax:
Mailing address:
  • Phone: 334-429-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberCNP231433
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-124680
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP231433
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: