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General NPI Number Information
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NPI Number | 1477824340
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Entity Type | Individual
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Provider Name | MICHAEL CRAIG COLOTTA FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 105 N HIGH ST
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City | HENDERSON
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State | TX
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Zip | 75652-3133
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Country | US
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Telephone | 903-392-8259
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Fax | 903-657-1674
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Provider Business Mailing Address
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Address Line | 879 COUNTY ROAD 135
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City | GARRISON
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State | TX
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Zip | 75946-6757
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Country | US
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Telephone | 936-556-0101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 689704
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License Number State | TX
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