Provider Demographics
NPI:1164880308
Name:COLLAZO EIJO, YORDENYS
Entity Type:Individual
Prefix:
First Name:YORDENYS
Middle Name:
Last Name:COLLAZO EIJO
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 1:7814 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3220
Mailing Address - Country:US
Mailing Address - Phone:813-405-3939
Mailing Address - Fax:813-405-3938
Practice Address - Street 1:7814 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3220
Practice Address - Country:US
Practice Address - Phone:813-405-3939
Practice Address - Fax:813-405-3938
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9321325363LA2100X
FL9321325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care