Healthcare Provider Details

I. General information

NPI: 1356090625
Provider Name (Legal Business Name): LISA MARIE COLLINS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 USA SOUTH DRIVE
MOBILE AL
36688-4402
US

IV. Provider business mailing address

5870 USA SOUTH DRIVE
MOBILE AL
36688-0002
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-7151
  • Fax: 251-414-8227
Mailing address:
  • Phone: 251-460-7151
  • Fax: 251-414-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11018815
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-125768
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: