Healthcare Provider Details

I. General information

NPI: 1831400423
Provider Name (Legal Business Name): HOLLY I COLANGELO MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 FAIRCHILD GARDENS AVE SUITE 101
PALM BEACH GARDENS FL
33410-2847
US

IV. Provider business mailing address

11505 FAIRCHILD GARDENS AVE SUITE 101
PALM BEACH GARDENS FL
33410-2847
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8001
  • Fax: 561-630-8007
Mailing address:
  • Phone: 561-630-8001
  • Fax: 561-630-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2104492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: