Provider Demographics
NPI:1932925914
Name:COLLADO, FANNY VIDALINA (NP)
Entity type:Individual
Prefix:
First Name:FANNY
Middle Name:VIDALINA
Last Name:COLLADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FANNY
Other - Middle Name:VIDALINA
Other - Last Name:COLLADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-FNP-BC
Mailing Address - Street 1:12055 SW 42ND MNR APT 111
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7995
Mailing Address - Country:US
Mailing Address - Phone:786-205-9901
Mailing Address - Fax:
Practice Address - Street 1:12055 SW 42ND MNR APT 111
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7995
Practice Address - Country:US
Practice Address - Phone:786-205-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily