Healthcare Provider Details

I. General information

NPI: 1992407555
Provider Name (Legal Business Name): THAINA COLON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE STE 150
OCOEE FL
34761-4523
US

IV. Provider business mailing address

1151 BLACKWOOD AVE STE 150
OCOEE FL
34761-4523
US

V. Phone/Fax

Practice location:
  • Phone: 407-378-0098
  • Fax:
Mailing address:
  • Phone: 407-378-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: