Provider Demographics
NPI:1659496958
Name:COLEEN L DOOLEY ARNP PA
Entity Type:Organization
Organization Name:COLEEN L DOOLEY ARNP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-745-8215
Mailing Address - Street 1:PO BOX 420346
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-0346
Mailing Address - Country:US
Mailing Address - Phone:305-745-8215
Mailing Address - Fax:
Practice Address - Street 1:2409 N ROOSEVELT BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3837
Practice Address - Country:US
Practice Address - Phone:305-745-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP624842261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3409OtherBLUE CROSS BLUE SHIELD
FL1972660082OtherNPI TYPE 1
FL034293900Medicaid
FLY4693Medicare ID - Type Unspecified