Healthcare Provider Details

I. General information

NPI: 1518452184
Provider Name (Legal Business Name): COLLEEN LYNN CULBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 NE 47TH ST STE 308
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

23540 FREDERICK RD
CLARKSBURG MD
20871-9709
US

V. Phone/Fax

Practice location:
  • Phone: 954-493-5005
  • Fax: 954-938-0957
Mailing address:
  • Phone: 512-731-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9495059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: