Healthcare Provider Details

I. General information

NPI: 1427832468
Provider Name (Legal Business Name): MARTIN CHANDLER COLLINS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 N 9TH ST UNIT 2
PHOENIX AZ
85020-8513
US

IV. Provider business mailing address

10410 N 9TH ST UNIT 2
PHOENIX AZ
85020-8513
US

V. Phone/Fax

Practice location:
  • Phone: 256-267-6897
  • Fax:
Mailing address:
  • Phone: 256-267-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number259295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: