Healthcare Provider Details

I. General information

NPI: 1518043942
Provider Name (Legal Business Name): SARAH ANN COLLINS C.D.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER U.S. COAST GUARD AVIATION TRAINING 8501 TANNER WILLIAMS RD.
MOBILE AL
36608
US

IV. Provider business mailing address

9500 BRONZEWOOD CT
MOBILE AL
36608-9417
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6404
  • Fax: 251-441-6415
Mailing address:
  • Phone: 251-776-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: