Healthcare Provider Details

I. General information

NPI: 1790882900
Provider Name (Legal Business Name): LONGBOAT CARDIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 GULF OF MEXICO DR
LONGBOAT KEY FL
34228-1906
US

IV. Provider business mailing address

5650 GULF OF MEXICO DR
LONGBOAT KEY FL
34228-1906
US

V. Phone/Fax

Practice location:
  • Phone: 941-383-7300
  • Fax: 941-383-7335
Mailing address:
  • Phone: 941-383-7300
  • Fax: 941-383-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME51094
License Number StateFL

VIII. Authorized Official

Name: MRS. COLLEEN MARY HEALY
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 941-383-7300