Healthcare Provider Details

I. General information

NPI: 1689514770
Provider Name (Legal Business Name): COLLEEN ELIZABETH VIRGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9793 W SAMPLE RD
CORAL SPRINGS FL
33065-4003
US

IV. Provider business mailing address

2710 NW 55TH AVE
MARGATE FL
33063-1530
US

V. Phone/Fax

Practice location:
  • Phone: 781-705-0567
  • Fax: 623-666-6792
Mailing address:
  • Phone: 954-644-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: