Healthcare Provider Details

I. General information

NPI: 1144373705
Provider Name (Legal Business Name): EDWARD MICHAEL COLLINS APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/20/2024
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR STE 121
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

3113 MOONLIGHT RIDGE ARC
LAS CRUCES NM
88011-1639
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7247
  • Fax:
Mailing address:
  • Phone: 201-406-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number76576
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NO111105
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00128900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: