Provider Demographics
NPI:1992966402
Name:NINA L. COLETTA DPM
Entity type:Organization
Organization Name:NINA L. COLETTA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-452-4590
Mailing Address - Street 1:9685 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2321
Mailing Address - Country:US
Mailing Address - Phone:954-452-4590
Mailing Address - Fax:954-452-0509
Practice Address - Street 1:9685 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2321
Practice Address - Country:US
Practice Address - Phone:954-452-4590
Practice Address - Fax:954-452-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2615213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340238000Medicaid
FL340238000Medicaid
FLE0076XMedicare PIN
FLAL442Medicare PIN