Healthcare Provider Details

I. General information

NPI: 1023497575
Provider Name (Legal Business Name): ASHLEA CHRISTA COLOSIMO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVENUE
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2100
  • Fax: 585-273-1171
Mailing address:
  • Phone: 585-275-2100
  • Fax: 585-273-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430906
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number630309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: