Provider Demographics
NPI:1770594830
Name:COLLURA, JUDY M (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:M
Last Name:COLLURA
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 1:5300 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2387
Mailing Address - Country:US
Mailing Address - Phone:561-227-5151
Mailing Address - Fax:
Practice Address - Street 1:5300 EAST AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2387
Practice Address - Country:US
Practice Address - Phone:561-848-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1504132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1504132OtherFLORIDA LICENSE
FLARNP1504132OtherFLORIDA LICENSE