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NPI Code Detail

MEDICARE: MR. MARCO ANTONIO COLON APN.

MEDICARE: MR. MARCO ANTONIO COLON APN.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner609318TX

General Provider Information

NPI Number : 1225114192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARCO ANTONIO COLON APN.
Provider Business Mailing Address
First Line : 5215 VISTA VERDE DR.
Second Line :
City : ARLINGTON
State : TX
Zip : 76017-1772
Country : US
Telephone Number : 817-375-9889
Fax Number :
Provider Business Practice Location Address
First Line : 1350 N WESTMORELAND DR
Second Line :
City : DALLAS
State : TX
Zip : 75211-1654
Country : US
Telephone Number : 214-330-0036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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