Provider Demographics
NPI:1891036372
Name:COLLIER MEDICAL, LLC
Entity Type:Organization
Organization Name:COLLIER MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-377-4088
Mailing Address - Street 1:15725 WILLO PINES LN
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3500
Mailing Address - Country:US
Mailing Address - Phone:862-377-4088
Mailing Address - Fax:
Practice Address - Street 1:12565 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5243
Practice Address - Country:US
Practice Address - Phone:239-455-9919
Practice Address - Fax:239-455-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113936261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care