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General NPI Number Information
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NPI Number | 1992966402
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Entity Type | Organization
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Legal Business Name | NINA L. COLETTA DPM
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 9685 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2321
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Country | US
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Telephone | 954-452-4590
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Fax | 954-452-0509
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Provider Business Mailing Address
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Address Line | 9685 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2321
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Country | US
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Telephone | 954-452-4590
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Fax | 954-452-0509
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NINA L. COLETTA
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Credential | DPM
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Telephone | 954-452-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2615
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License Number State | FL
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