Healthcare Provider Details

I. General information

NPI: 1699716472
Provider Name (Legal Business Name): COLLEEN MARY HEALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/29/2012
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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME51094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: