Provider Demographics
NPI:1528174216
Name:PALMISANO, COLLETTE (ARNP)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:PALMISANO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OAK MANOR LN APT 46
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1214
Mailing Address - Country:US
Mailing Address - Phone:727-489-3305
Mailing Address - Fax:727-499-9559
Practice Address - Street 1:3600 OAK MANOR LN APT 46
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1214
Practice Address - Country:US
Practice Address - Phone:727-489-3305
Practice Address - Fax:727-499-9559
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3135202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00090663OtherRAILROAD MEDICARE
5888704OtherAETNA
FLY7570OtherBCBS
FL305481100Medicaid
5888704OtherAETNA
FLE0042TMedicare PIN