Provider Demographics
NPI:1205072972
Name:GARCIA, COLLEEN MARIE (RN,BSN)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 MALON BAY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6801
Mailing Address - Country:US
Mailing Address - Phone:321-662-5964
Mailing Address - Fax:407-668-4064
Practice Address - Street 1:1504 MALON BAY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6801
Practice Address - Country:US
Practice Address - Phone:321-662-5964
Practice Address - Fax:407-668-4064
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230682172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker