Healthcare Provider Details

I. General information

NPI: 1306774609
Provider Name (Legal Business Name): KRISTINE COLLINS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 F AVE
CORONADO CA
92118-2199
US

IV. Provider business mailing address

550 F AVE
CORONADO CA
92118-2199
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-8921
  • Fax: 619-522-6948
Mailing address:
  • Phone: 619-522-8921
  • Fax: 619-522-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number579983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: