Active NPI
Colleen Tetzlaff, FNP
- Family Nurse Practitioner
- Portland, ME
National Provider Identifier
1710083233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP81384
- Practice address
- 222 Auburn St
Ste 103
Portland, ME 04103-6005 - Phone
- (207) 699-3838
- Fax
- (855) 216-3778
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP81384 | ME | Primary |
Addresses
Primary practice location
222 Auburn St
Ste 103
Portland, ME 04103-6005
Mailing address
PO Box 1638
Albany, NY 12201-1638
Phone (207) 777-4111
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30344710 | Medicaid | NH | |
| 432379199 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1997
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
60 Forest Falls Dr
Suite 5
Yarmouth, ME 04096-6971
Phone 2076993838993838
Hospital & facility affiliations
- Northern Light Mercy Hospital
- Mainehealth Maine Medical Center
- Mainehealth Mid Coast Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP81384 | ME | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jade Trade Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Nurse Practitioner
- Portland, ME
- NPI 1063851046
-
- Physical Therapist
- Portland, ME
- NPI 1578753836
Hospital & facility affiliations 39
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
-
- General Acute Care Hospital
- Portland, ME
- NPI 1346267879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553472000000",
"number": "1710083233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1638",
"city": "ALBANY",
"state": "NY",
"postal_code": "122011638",
"telephone_number": "207-777-4111",
"fax_number": "207-783-6660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 AUBURN ST",
"address_2": "STE 103",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041036005",
"telephone_number": "207-699-3838",
"fax_number": "855-216-3778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETZLAFF",
"first_name": "COLLEEN",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2019-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ME",
"license": "CNP81384",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30344710",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "432379199",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.