Provider Demographics
NPI:1932730785
Name:COLES, JUANA AMALFI (APRN)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:AMALFI
Last Name:COLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3326
Mailing Address - Country:US
Mailing Address - Phone:754-444-8826
Mailing Address - Fax:954-856-2921
Practice Address - Street 1:3898 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-3326
Practice Address - Country:US
Practice Address - Phone:754-444-8826
Practice Address - Fax:954-856-2921
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine