Healthcare Provider Details

I. General information

NPI: 1003619073
Provider Name (Legal Business Name): BLISS CORBITT COLAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLISS CORBITT WILSON

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER STE 410
GAINESVILLE FL
32606-9281
US

IV. Provider business mailing address

4037 NW 86TH TER
GAINESVILLE FL
32606-9281
US

V. Phone/Fax

Practice location:
  • Phone: 352-594-1500
  • Fax:
Mailing address:
  • Phone: 352-594-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberTRN44924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: