Provider Demographics
NPI:1902640147
Name:COLON, JOSHUA (PMD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 GATEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6056
Mailing Address - Country:US
Mailing Address - Phone:321-370-4988
Mailing Address - Fax:
Practice Address - Street 1:1425 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-6056
Practice Address - Country:US
Practice Address - Phone:321-370-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT544409146N00000X
FLPMD528429146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic