Healthcare Provider Details

I. General information

NPI: 1861218372
Provider Name (Legal Business Name): DAILEN COLLAZO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 S US HIGHWAY 1 STE 101
PORT ST LUCIE FL
34952-3453
US

IV. Provider business mailing address

PO BOX 4189
DEERFIELD BEACH FL
33442-4189
US

V. Phone/Fax

Practice location:
  • Phone: 772-398-1305
  • Fax: 772-398-1307
Mailing address:
  • Phone: 954-363-9582
  • Fax: 954-363-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: