Provider Demographics
NPI:1568002921
Name:COLLADO, JESSICA HELEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELEN
Last Name:COLLADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 CARAMBOLA CIR S
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2300
Mailing Address - Country:US
Mailing Address - Phone:786-318-4917
Mailing Address - Fax:
Practice Address - Street 1:2766 CARAMBOLA CIR S
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2300
Practice Address - Country:US
Practice Address - Phone:786-318-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily