Healthcare Provider Details

I. General information

NPI: 1982098083
Provider Name (Legal Business Name): COLLIER HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW HEALTH PKWY
NAPLES FL
34109-0473
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-3131
  • Fax: 239-592-1877
Mailing address:
  • Phone: 239-658-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMI RAZNOFF
Title or Position: CFO
Credential:
Phone: 239-658-3000