Colleen Flora Petullo, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RNP227728 Issued in AZ

Practice address

9695 N. Fiorella St.
Prescott Valley, AZ 86315

Phone

(702) 460-9009

NPI assigned

Aug 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1790333003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9695 N. FIORELLA ST.",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86315",
            "telephone_number": "928-312-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9695 N. FIORELLA ST.",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86315",
            "telephone_number": "702-460-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETULLO",
        "first_name": "COLLEEN",
        "middle_name": "FLORA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "59225",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "RNP227728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cp826@nau.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9695 N. Fiorella St.",
            "city": "Prescott Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "86315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeremy James Pene, NP
• People First
• People First
• Katie Lynne Peterson, PA-C
• Eileen Kim Petrocelli, IBCLC
• Jill Ann Pfister, M.A.CCC-SLP
• Nicholas Phair, PA
• Physician Business Serivces, LLC
• Physician Business Services, LLC
• Kristin Pifer, P.T.

• Family Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.