Provider Demographics
NPI:1831354109
Name:CRAWFORD, COLLEEN M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:FINEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:PO BOX 95590
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0590
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 401B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:448-227-4160
Practice Address - Fax:448-227-4160
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107885363AM0700X
ALPA.1381363AM0700X
KS15-01537363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1610042OtherMEDICARE PTAN
KS15-01537OtherKS LICENSE
KS200970330AMedicaid