Provider Demographics
NPI:1487618260
Name:COLABIANCHI, ANGELO SAMUEL (PA)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:SAMUEL
Last Name:COLABIANCHI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TURNER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5228
Mailing Address - Country:US
Mailing Address - Phone:850-452-5242
Mailing Address - Fax:
Practice Address - Street 1:450 TURNER ST
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5228
Practice Address - Country:US
Practice Address - Phone:850-452-5242
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant