Provider Demographics
NPI:1356578348
Name:COLLIE, ELIZABETH SOPHIA (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SOPHIA
Last Name:COLLIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SOPHIA
Other - Last Name:COLLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:9 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-4294
Mailing Address - Country:US
Mailing Address - Phone:386-365-5221
Mailing Address - Fax:
Practice Address - Street 1:2862 NW SUWANNEE VALLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5603
Practice Address - Country:US
Practice Address - Phone:386-365-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203771363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFR304ZMedicare PIN