Provider Demographics
NPI:1215921333
Name:GLEASON, COLLEEN M (FNP/PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:GLEASON
Suffix:
Gender:
Credentials:FNP/PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5118
Mailing Address - Country:US
Mailing Address - Phone:559-732-1648
Mailing Address - Fax:559-732-0664
Practice Address - Street 1:5315 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5118
Practice Address - Country:US
Practice Address - Phone:559-732-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 10971OtherNURSE PRACTIIONER LICENSE
CAZZZ16640ZMedicare ID - Type Unspecified