1558661322 NPI number — COLEEN L DOOLEY ARNP PLLC

Table of content: (NPI 1558661322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558661322 NPI number — COLEEN L DOOLEY ARNP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLEEN L DOOLEY ARNP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558661322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 420346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERLAND KEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33042-0346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-745-8215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2409 N ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-745-8215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOOLEY
Authorized Official First Name:
COLEEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR/SOLE PROVIDER
Authorized Official Telephone Number:
305-745-3768

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  ARNP 624842 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: ARNP 624842 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659496958 . This is a "NPI TYPE 2" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1972660082 . This is a "NPI TYPE 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 034293900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y3409 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".