Provider Demographics
NPI:1174839732
Name:COLLAZO, CAROLINA P (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:P
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9430 TURKEY LAKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8015
Mailing Address - Country:US
Mailing Address - Phone:321-841-7856
Mailing Address - Fax:321-843-6432
Practice Address - Street 1:9430 TURKEY LAKE RD STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:321-841-7856
Practice Address - Fax:321-843-6432
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124410207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102106600Medicaid
FL14ZY6OtherFLORIDA BLUE