Healthcare Provider Details

I. General information

NPI: 1891857702
Provider Name (Legal Business Name): COLLIER PATHOLOGY SERVICES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

5755 HOOVER BLVD
TAMPA FL
33634-5340
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4319
  • Fax: 239-304-5087
Mailing address:
  • Phone: 813-886-8334
  • Fax: 813-890-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME81670
License Number StateFL

VIII. Authorized Official

Name: BRUNO DIPASQUALE
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 239-348-4319