Individual
COLLEEN L URSIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
655 N CLYDE MORRIS BLVD STE B, DAYTONA BEACH, FL 32114-2321
(386) 252-5578
Mailing address
4651 VAN DYKE RD, LUTZ, FL 33558-4880
(813) 321-1786
(813) 321-1787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9108889
FL
Other
Enumeration date
09/03/2015
Last updated
01/16/2019
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