Basic Information
| Provider Information | |||||||||
| NPI: | 1871178335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLACINO | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753043 | ||||||||
| FaxNumber: | 3307064856 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 JEAN DR | ||||||||
| Address2: | |||||||||
| City: | HUBBARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444251665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309841620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2021 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 57007374RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 50007374RX | 01 | OH | STATE LICENSE | OTHER |