Provider Demographics
NPI:1699716472
Name:HEALY, COLLEEN MARY (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARY
Last Name:HEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 GULF OF MEXICO DR
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-1906
Mailing Address - Country:US
Mailing Address - Phone:941-383-7300
Mailing Address - Fax:941-383-7335
Practice Address - Street 1:5650 GULF OF MEXICO DR
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-1906
Practice Address - Country:US
Practice Address - Phone:941-383-7300
Practice Address - Fax:941-383-7335
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51094207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064203700Medicaid
FL01201OtherUNIVERSAL HEALTHCARE
FL10903OtherBC/BS FLORIDA
FL4281853OtherAETNA
FL4363736001OtherCIGNA
FL10903AMedicare ID - Type Unspecified
FL01201OtherUNIVERSAL HEALTHCARE