Healthcare Provider Details

I. General information

NPI: 1972988962
Provider Name (Legal Business Name): COLLEEN MICHELE DRISCOLL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN MICHELE DUFFY

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 INDUSTRIAL PKWY N STE 110
BRUNSWICK OH
44212-6366
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-6468
  • Fax: 330-225-6534
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: