Provider Demographics
NPI:1487093548
Name:SMALL, COLLEEN PATRICIA (CNA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:SMALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 NW 55TH AVE
Mailing Address - Street 2:APARTMENT 1 C
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1418
Mailing Address - Country:US
Mailing Address - Phone:954-661-3090
Mailing Address - Fax:954-530-6958
Practice Address - Street 1:7551 KISMET ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5946
Practice Address - Country:US
Practice Address - Phone:954-391-9516
Practice Address - Fax:954-530-6958
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 38957376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide