Provider Demographics
NPI:1962166884
Name:COLIN ATANACIO, JOSE DANIEL (FNP-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:COLIN ATANACIO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:DANIEL
Other - Last Name:COLIN ATANACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COLIN ATANACIO
Mailing Address - Street 1:3017 CARSON LN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6391
Mailing Address - Country:US
Mailing Address - Phone:903-517-7518
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E STE 135
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3481
Practice Address - Country:US
Practice Address - Phone:979-703-1832
Practice Address - Fax:979-703-1937
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily