Healthcare Provider Details

I. General information

NPI: 1821365420
Provider Name (Legal Business Name): BRITTANY ANNE COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

143 WINDWALKER RD
BUENA VISTA CO
81211-8507
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1995
  • Fax:
Mailing address:
  • Phone: 219-477-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0003607
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: