Healthcare Provider Details

I. General information

NPI: 1295842862
Provider Name (Legal Business Name): MARILU COLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOHNS MEDICAL PARK DR
ST AUGUSTINE FL
32086-5300
US

IV. Provider business mailing address

2100 KINGSLEY AVE
ORANGE PARK FL
32073-5130
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-0869
  • Fax: 904-826-0966
Mailing address:
  • Phone: 904-276-0001
  • Fax: 904-276-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14631
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME126977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: