MEDICARE: SERGO COLIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F12190038	FL

General Provider Information

NPI Number	:	1043858434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGO COLIN FNP

Provider Business Mailing Address
First Line	:	1665 NE 159TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 NE 159TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4739
Country	:	US
Telephone Number	:	305-896-0750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	02/01/2024

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