Healthcare Provider Details

I. General information

NPI: 1427685809
Provider Name (Legal Business Name): JENNIFER NICOLE COLLIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-6890
  • Fax:
Mailing address:
  • Phone: 859-323-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV3845
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberV3845
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: