Provider Demographics
NPI:1912555475
Name:COLBERT, MARIA RENEE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:RENEE
Last Name:COLBERT
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 1:18552 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2774
Mailing Address - Country:US
Mailing Address - Phone:954-551-2907
Mailing Address - Fax:
Practice Address - Street 1:18552 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2774
Practice Address - Country:US
Practice Address - Phone:954-551-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider