Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 21228 | SC |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 21228 | SC |
NPI | 1003331158 |
---|---|
Provider Name | Jason Collins |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2017 |
Last Update Date | 23/05/2021 |