Healthcare Provider Details

I. General information

NPI: 1245953215
Provider Name (Legal Business Name): HEALTHCARE COLLEAGUES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MAITLAND AVE STE 1001
ALTAMONTE SPRINGS FL
32701-5448
US

IV. Provider business mailing address

411 MAITLAND AVE STE 1001
ALTAMONTE SPRINGS FL
32701-5448
US

V. Phone/Fax

Practice location:
  • Phone: 407-260-2606
  • Fax:
Mailing address:
  • Phone: 407-260-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TELLERIA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 407-260-2606