Healthcare Provider Details

I. General information

NPI: 1417889320
Provider Name (Legal Business Name): ALLISON CHUNN COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 ROYAL PORT CT
BELLVIEW FL
32526-1739
US

IV. Provider business mailing address

6016 ROYAL PORT CT
BELLVIEW FL
32526-1739
US

V. Phone/Fax

Practice location:
  • Phone: 662-251-7554
  • Fax:
Mailing address:
  • Phone: 662-251-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11046886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: