MEDICARE: COLLEEN ELLEN SCARLETT LM

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	176B00000X	Midwife	MW219	FL

General Provider Information

NPI Number	:	1386882041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ELLEN SCARLETT LM

Provider Business Mailing Address
First Line	:	2000 JEFFERSON ST APT 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6939
Country	:	US
Telephone Number	:	786-399-6399
Fax Number	:	786-206-3828

Provider Business Practice Location Address
First Line	:	3001 W HALLANDALE BEACH BLVD STE 2
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5155
Country	:	US
Telephone Number	:	954-456-4888
Fax Number	:

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

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	04/19/2018

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