Provider Demographics
NPI:1417140344
Name:COLLUPY, GRACE EVELYN (CNM)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EVELYN
Last Name:COLLUPY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:EVELYN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:719 RODEL CV
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5716
Mailing Address - Country:US
Mailing Address - Phone:407-262-5710
Mailing Address - Fax:
Practice Address - Street 1:719 RODEL CV
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5716
Practice Address - Country:US
Practice Address - Phone:407-262-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9244471367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308599600Medicaid
FL308599600Medicaid
FLAL362ZMedicare PIN