Individual
LAURA MATIAS COLLAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1005 N LAKE PARKER AVE, LAKELAND, FL 33805-4723
(863) 583-4053
(863) 248-8268
Mailing address
12171 SW 268TH ST, HOMESTEAD, FL 33032-8001
(305) 278-0200
(305) 851-4110
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9335260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN9335260
RN
FL
Enumeration date
07/11/2017
Last updated
07/11/2017
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