Healthcare Provider Details

I. General information

NPI: 1447996525
Provider Name (Legal Business Name): COLLEEN DIGIACOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 8TH ST STE 2L
PHILADELPHIA PA
19106-4017
US

IV. Provider business mailing address

301 S 8TH ST STE 2L
PHILADELPHIA PA
19106-4017
US

V. Phone/Fax

Practice location:
  • Phone: 267-322-7700
  • Fax: 215-689-0296
Mailing address:
  • Phone: 267-322-7700
  • Fax: 215-689-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN691652
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: