Healthcare Provider Details

I. General information

NPI: 1164880308
Provider Name (Legal Business Name): YORDENYS COLLAZO EIJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14027 5TH ST
DADE CITY FL
33525-4302
US

IV. Provider business mailing address

PO BOX 232
DADE CITY FL
33526-0232
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax: 352-567-0218
Mailing address:
  • Phone: 352-518-2000
  • Fax: 352-567-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9321325
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9321325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: