Provider Demographics
NPI:1528757812
Name:COLSON-SMITH, JACQUESHA
Entity type:Individual
Prefix:
First Name:JACQUESHA
Middle Name:
Last Name:COLSON-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VINTAGE PARK BLVD
Mailing Address - Street 2:STE A #377
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:713-588-4677
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR SUITE 2019
Practice Address - Street 2:STE A #377
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:713-588-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula