Healthcare Provider Details

I. General information

NPI: 1346640356
Provider Name (Legal Business Name): MARIE MILAGROS COLLAZO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 AVALON PARK WEST BLVD STE 205
ORLANDO FL
32828-7303
US

IV. Provider business mailing address

3701 AVALON PARK WEST BLVD STE 205
ORLANDO FL
32828-7303
US

V. Phone/Fax

Practice location:
  • Phone: 407-306-0982
  • Fax: 407-384-7754
Mailing address:
  • Phone: 407-306-0982
  • Fax: 407-384-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9299132
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9299132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: