Provider Demographics
NPI:1649487885
Name:COLLETTE, JUDITH (ARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 COLLEGE PKWY
Mailing Address - Street 2:B4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5191
Mailing Address - Country:US
Mailing Address - Phone:239-481-9999
Mailing Address - Fax:239-481-9346
Practice Address - Street 1:8595 COLLEGE PKWY
Practice Address - Street 2:B4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5191
Practice Address - Country:US
Practice Address - Phone:239-481-9999
Practice Address - Fax:239-481-9346
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2040832163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory