Provider Demographics
NPI:1942519079
Name:COLLAZO, ALEJANDRA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ALEJANDRA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 WEST PARK DRIVE
Mailing Address - Street 2:APT 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:305-594-4421
Mailing Address - Fax:305-594-4644
Practice Address - Street 1:680 W PARK DR
Practice Address - Street 2:APT 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5354
Practice Address - Country:US
Practice Address - Phone:305-594-4421
Practice Address - Fax:305-594-4644
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1246889942153OtherPALS