MEDICARE: ELIZABETH SOPHIA COLLIE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	ARNP9203771	FL
2	363LG0600X	Gerontology Nurse Practitioner	ARNP9203771	FL

General Provider Information

NPI Number	:	1356578348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SOPHIA COLLIE APRN

Provider Business Mailing Address
First Line	:	9 HEMLOCK CT
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34472-4294
Country	:	US
Telephone Number	:	386-365-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2862 NW SUWANNEE VALLEY RD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-5603
Country	:	US
Telephone Number	:	386-365-5221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/14/2022

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