Healthcare Provider Details

I. General information

NPI: 1760693121
Provider Name (Legal Business Name): ELIZABETH PATRICIA COLLINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S BALDWIN AVE
ARCADIA FL
34266-3387
US

IV. Provider business mailing address

34 S BALDWIN AVE
ARCADIA FL
34266-3387
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-4601
  • Fax: 863-993-4606
Mailing address:
  • Phone: 863-993-4601
  • Fax: 863-993-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3203732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: