Provider Demographics
NPI:1194093476
Name:HERR, COLLEEN EVANSON
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:EVANSON
Last Name:HERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:EVANSON
Other - Last Name:HERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:28078 BAXTER RD
Mailing Address - Street 2:STE 530
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1405
Mailing Address - Country:US
Mailing Address - Phone:760-436-8881
Mailing Address - Fax:760-436-1022
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:SUITE 102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-436-8881
Practice Address - Fax:760-436-1022
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493591163W00000X
CA11633363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse