Provider Demographics
NPI:1164785127
Name:COLON, LUIS ALEXIS (LCNA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALEXIS
Last Name:COLON
Suffix:
Gender:M
Credentials:LCNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 NE 28TH AVE
Mailing Address - Street 2:LOT 103
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-1236
Mailing Address - Country:US
Mailing Address - Phone:352-804-4131
Mailing Address - Fax:
Practice Address - Street 1:231 NE 28TH AVE
Practice Address - Street 2:LOT 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-1236
Practice Address - Country:US
Practice Address - Phone:352-804-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 124555376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide