Provider Demographics
NPI:1346640356
Name:COLLAZO, MARIE MILAGROS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MILAGROS
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 AVALON PARK WEST BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7303
Mailing Address - Country:US
Mailing Address - Phone:407-306-0982
Mailing Address - Fax:407-384-7754
Practice Address - Street 1:3701 AVALON PARK WEST BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7303
Practice Address - Country:US
Practice Address - Phone:407-306-0982
Practice Address - Fax:407-384-7754
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299132363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology