Provider Demographics
NPI:1205264983
Name:MURPHY, COLLIN
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 CENTER LAKE DR
Mailing Address - Street 2:APT 6309
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5591
Mailing Address - Country:US
Mailing Address - Phone:631-338-1412
Mailing Address - Fax:
Practice Address - Street 1:11373 CENTER LAKE DR
Practice Address - Street 2:APT 6309
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5591
Practice Address - Country:US
Practice Address - Phone:631-338-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health