Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | ARNP9167802 | FL |
NPI | 1356667927 |
---|---|
Provider Name | Colleen O Collins |
First Address | Bartow, FL 33830-6740 |
Second Address | Lakeland, FL 33805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 06/04/2012 |