Healthcare Provider Details

I. General information

NPI: 1043133069
Provider Name (Legal Business Name): COLLEEN HUSTED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 ARDEN CIR
MELBOURNE FL
32934-8773
US

IV. Provider business mailing address

3215 ARDEN CIR
MELBOURNE FL
32934-8773
US

V. Phone/Fax

Practice location:
  • Phone: 321-745-0592
  • Fax:
Mailing address:
  • Phone: 321-745-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: