Healthcare Provider Details

I. General information

NPI: 1871879635
Provider Name (Legal Business Name): JAIMEE BLAIR COLLINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST
SAN LUIS OBISPO CA
93405-5803
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-269-1500
  • Fax: 805-269-1585
Mailing address:
  • Phone: 805-361-8028
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: