Healthcare Provider Details

I. General information

NPI: 1912861881
Provider Name (Legal Business Name): COLIN TIMOTHY LEONARD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE
TROY NY
12180-2466
US

IV. Provider business mailing address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-8600
  • Fax: 518-271-3440
Mailing address:
  • Phone: 518-525-8600
  • Fax: 518-525-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: