Healthcare Provider Details

I. General information

NPI: 1619765930
Provider Name (Legal Business Name): ASHLY COLLINS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24123 GREENFIELD RD STE 211
SOUTHFIELD MI
48075-3140
US

IV. Provider business mailing address

24123 GREENFIELD RD STE 211
SOUTHFIELD MI
48075-3140
US

V. Phone/Fax

Practice location:
  • Phone: 248-701-0854
  • Fax:
Mailing address:
  • Phone: 248-701-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704386945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: