Provider Demographics
NPI:1306414453
Name:COLON COLON, BERENICE (MD)
Entity Type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:COLON COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1142
Mailing Address - Country:US
Mailing Address - Phone:787-621-3700
Mailing Address - Fax:
Practice Address - Street 1:8075 SW STATE RD 200, STE 118
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481
Practice Address - Country:US
Practice Address - Phone:352-414-4511
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16-164207Q00000X
FLACN1606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty