Healthcare Provider Details

I. General information

NPI: 1205882933
Provider Name (Legal Business Name): AUDREY CARON LLEVA COLLINS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 S GREENWOOD AVE STE 106-108
CHICAGO IL
60619-7061
US

IV. Provider business mailing address

2648 W CRYSTAL ST
CHICAGO IL
60622-2812
US

V. Phone/Fax

Practice location:
  • Phone: 773-920-2755
  • Fax:
Mailing address:
  • Phone: 773-395-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11006328
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202103160NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP136652
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61487255
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209000104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: