Healthcare Provider Details

I. General information

NPI: 1093093957
Provider Name (Legal Business Name): MICHAEL COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL COLLINS CRNA

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 E SHEA BLVD SUITE 101
SCOTTSDALE AZ
85260-6662
US

IV. Provider business mailing address

7701 W SAINT JOHN RD APT 1141
GLENDALE AZ
85308-8608
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-6620
  • Fax: 480-596-8522
Mailing address:
  • Phone: 623-215-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number173723
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: