Healthcare Provider Details

I. General information

NPI: 1144269176
Provider Name (Legal Business Name): COLLEEN MARY CRANDELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 WEBB RD
TAMPA FL
33615-4518
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 813-882-9986
  • Fax: 813-882-9849
Mailing address:
  • Phone: 813-882-9986
  • Fax: 813-882-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number227706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: