MEDICARE: COLBY BETH MICKARTZ AG-ACNP

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	363L00000X	Nurse Practitioner	CNP241192	ME
2	363LA2100X	Acute Care Nurse Practitioner	CNP241192	ME

General Provider Information

NPI Number	:	1164263489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLBY BETH MICKARTZ AG-ACNP

Provider Business Mailing Address
First Line	:	5 HARRIS CT STE 201
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-5750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HARRIS CT STE 201
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-5750
Country	:	US
Telephone Number	:	831-375-4105
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	12/10/2025

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