Axel Collazo

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN11000641 Issued in FL

Practice address

18861 NW 86TH CT Apt 3901
Hialeah, FL 33015-7231

Phone

(954) 235-0463

NPI assigned

Dec 27, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Dolphin Health Care Corp

  • Psychiatric/Mental Health Nurse Practitioner
  • Orlando, FL
  • NPI 1477990869
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582934400000",
    "number": "1710459029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18861 NW 86TH CT APT 3901",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330157231",
            "telephone_number": "954-235-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18861 NW 86TH CT APT 3901",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330157231",
            "telephone_number": "954-235-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "AXEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-27",
        "last_updated": "2020-02-29",
        "certification_date": "2020-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11000641",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11000641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Collantes, BCABA
• Jissuan Gabriel Collazo Collado
• Daniela Collazo Rodriguez
• Yanet Collazo Vazquez
• Melany Collazo Vigoa
• Briana Collazo, RBT
• Maria Lourdes Collazo
• Reina Collazo
• Yaraled De la Caridad Collazo
• Tania Collazos Erazo

• Gerontology Nurse Practitioner in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.