Healthcare Provider Details

I. General information

NPI: 1992660328
Provider Name (Legal Business Name): COLLIER HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13753 IMMOKALEE RD
NAPLES FL
34120-7602
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax:
Mailing address:
  • Phone: 239-658-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMI RAZNOFF
Title or Position: CFO
Credential:
Phone: 239-986-0136