Provider Demographics
NPI:1528098217
Name:COLOMA, CAROL ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:COLOMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8994 ROTHERHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3137
Mailing Address - Country:US
Mailing Address - Phone:703-258-5824
Mailing Address - Fax:
Practice Address - Street 1:2760 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2110
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024127996363LF0000X
MDAC000700363LF0000X
DCRN1021524363LF0000X
CA95000770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02020N18Medicare PIN
VAS80904Medicare UPIN
VAMC11111Medicare UPIN
P00234363Medicare PIN
VA142930ZCCUMedicare PIN
00W411N16Medicare PIN