MEDICARE: COLEEN ROSEMARIE THOMPSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	SP021591	PA
2	363LG0600X	Gerontology Nurse Practitioner	AC002697	MD
3	363LG0600X	Gerontology Nurse Practitioner	LP-0000290	DE
4	363LG0600X	Gerontology Nurse Practitioner	0024174685	VA
5	363LG0600X	Gerontology Nurse Practitioner	NP1044486	DC
6	363LG0600X	Gerontology Nurse Practitioner	APRN9274750	FL
7	363LG0600X	Gerontology Nurse Practitioner	5010483	NC

General Provider Information

NPI Number	:	1144475872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLEEN ROSEMARIE THOMPSON NP

Provider Business Mailing Address
First Line	:	PO BOX 580645
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-0008
Country	:	US
Telephone Number	:	407-453-0450
Fax Number	:	855-823-7071

Provider Business Practice Location Address
First Line	:	PO BOX 580645
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-0008
Country	:	US
Telephone Number	:	407-453-0450
Fax Number	:	855-823-7071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	03/04/2026

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