Provider Demographics
NPI:1194979955
Name:KOLBIAZ, JENNIFER LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:KOLBIAZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:855-298-9888
Mailing Address - Fax:989-497-3125
Practice Address - Street 1:4677 TOWNE CENTRE RD STE 301
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:855-298-9888
Practice Address - Fax:989-497-3128
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI194526OtherGREAT LAKES HEALTH PLAN
MI500G310570OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI62748OtherMERIDIAN HEALTH PLAN
MI078OtherCARE SOURCE OF MICHIGAN
MI381908328OtherHCAP
MO1194979955OtherMOLINA HEALTH CARE OF MICHIGAN
MI1194979955Medicaid
MI381908328OtherHCAP