Provider Demographics
NPI:1275744880
Name:CALLAHAN, COLLEEN C (LPN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:C
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 SE PACE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6220
Mailing Address - Country:US
Mailing Address - Phone:772-878-3483
Mailing Address - Fax:
Practice Address - Street 1:709 S 5TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8339
Practice Address - Country:US
Practice Address - Phone:772-468-5601
Practice Address - Fax:772-468-5633
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5163250164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse