Provider Demographics
NPI:1861286890
Name:LONDON COLLECTIVE LLC
Entity type:Organization
Organization Name:LONDON COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDONO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:813-954-2220
Mailing Address - Street 1:8915 FORGE BREEZE LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-2331
Mailing Address - Country:US
Mailing Address - Phone:813-954-2220
Mailing Address - Fax:
Practice Address - Street 1:16506 POINTE VILLAGE DR STE 207
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5254
Practice Address - Country:US
Practice Address - Phone:813-954-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care