Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME111000 | FL |
Y | 208600000X | Surgeon | ME111000 | FL |
NPI | 1023022431 |
---|---|
Provider Name | Raquel Marie Collins |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Zephyrhills, FL 33542-7505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 22/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004265500 | (05) | FL |