MEDICARE: MRS. VICKIE RENEE COLLINS APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APN11917	TN

General Provider Information

NPI Number	:	1972552198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKIE RENEE COLLINS APRN, BC

Provider Business Mailing Address
First Line	:	1970 JORDAN AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-1900
Country	:	US
Telephone Number	:	423-790-7662
Fax Number	:	423-790-7664

Provider Business Practice Location Address
First Line	:	1970 JORDAN AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-1900
Country	:	US
Telephone Number	:	423-790-7662
Fax Number	:	423-790-7664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	12/27/2016

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