Provider Demographics
NPI:1114330354
Name:COLEMAN, DOTLYN
Entity Type:Individual
Prefix:
First Name:DOTLYN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WESTFORD DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5647
Mailing Address - Country:US
Mailing Address - Phone:321-303-4907
Mailing Address - Fax:407-523-3798
Practice Address - Street 1:3410 WESTFORD DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5647
Practice Address - Country:US
Practice Address - Phone:321-303-4907
Practice Address - Fax:407-523-3798
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9204897163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142490400Medicaid