Provider Demographics
NPI:1942619853
Name:KOLAT, KRISTIN MARIE (APRN)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MARIE
Last Name:KOLAT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAYNES ST STE A
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4111
Mailing Address - Country:US
Mailing Address - Phone:860-533-0008
Mailing Address - Fax:860-533-0019
Practice Address - Street 1:515 MIDDLE TPKE W STE 120
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3816
Practice Address - Country:US
Practice Address - Phone:860-533-0008
Practice Address - Fax:860-533-0019
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily