MEDICARE: JOAN M COLLETT 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	363L00000X	Nurse Practitioner	369162-4408	UT
2	363LA2200X	Adult Health Nurse Practitioner	369162-4405	UT

General Provider Information

NPI Number	:	1164703328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN M COLLETT NP

Provider Business Mailing Address
First Line	:	2000 CIRCLE OF HOPE DR
Second Line	:	ROOM N1550
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-213-4270
Fax Number	:	801-585-7902

Provider Business Practice Location Address
First Line	:	1055 N 500 W STE 202, BLDG C
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-8460
Country	:	US
Telephone Number	:	801-374-2367
Fax Number	:	801-429-8015

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

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	07/21/2022

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