MEDICARE: TONI NICHOLE COLLADO 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	363LP2300X	Primary Care Nurse Practitioner	95027988	CA
2	363LA2100X	Acute Care Nurse Practitioner	95027988	CA

General Provider Information

NPI Number	:	1588423743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI NICHOLE COLLADO NP

Provider Business Mailing Address
First Line	:	208 ANACAPA # 208
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-2302
Country	:	US
Telephone Number	:	657-282-1369
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 S SANTA CRUZ ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-6821
Country	:	US
Telephone Number	:	714-577-2124
Fax Number	:	714-577-2125

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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