Provider Demographics
NPI:1568518108
Name:CINDYLEE CALALUCA'S FORGOTTEN COAST PODIATRY & HAPPY FEET BOUTIQUE
Entity Type:Organization
Organization Name:CINDYLEE CALALUCA'S FORGOTTEN COAST PODIATRY & HAPPY FEET BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALALUCA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-984-0090
Mailing Address - Street 1:1329 COASTAL HIGHWAY
Mailing Address - Street 2:P.O. BOX 646
Mailing Address - City:PANACEA
Mailing Address - State:FL
Mailing Address - Zip Code:32346
Mailing Address - Country:US
Mailing Address - Phone:850-984-0090
Mailing Address - Fax:850-984-8156
Practice Address - Street 1:1329 COASTAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:PANACEA
Practice Address - State:FL
Practice Address - Zip Code:32346
Practice Address - Country:US
Practice Address - Phone:850-984-0090
Practice Address - Fax:850-984-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1973213EP1101X
FLARNP2185832363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty