Healthcare Provider Details

I. General information

NPI: 1861286890
Provider Name (Legal Business Name): LONDON COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16506 POINTE VILLAGE DR STE 207
LUTZ FL
33558-5254
US

IV. Provider business mailing address

8915 FORGE BREEZE LOOP
WESLEY CHAPEL FL
33545-2331
US

V. Phone/Fax

Practice location:
  • Phone: 813-954-2220
  • Fax:
Mailing address:
  • Phone: 813-954-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELA LONDONO
Title or Position: OWNER/NURSE PRACTITIONER
Credential: DNP
Phone: 813-954-2220