Provider Demographics
NPI:1912459272
Name:ENDOCRINE HEALTH AND WELLNESS OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:ENDOCRINE HEALTH AND WELLNESS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-951-2152
Mailing Address - Street 1:14720 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7450
Mailing Address - Country:US
Mailing Address - Phone:305-951-2152
Mailing Address - Fax:
Practice Address - Street 1:12060 SW 129TH CT STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4582
Practice Address - Country:US
Practice Address - Phone:786-592-2744
Practice Address - Fax:949-404-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X
FLOS11351261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205123742OtherNPI NUMBER
FL006303500Medicaid
FLFU342ZMedicare UPIN