Healthcare Provider Details

I. General information

NPI: 1114550415
Provider Name (Legal Business Name): ERICA MARIE COLLINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 06/17/2025
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28315 NY 206
DOWNSVILLE NY
13755
US

IV. Provider business mailing address

2 TITUS PLACE
WALTON NY
13856-1455
US

V. Phone/Fax

Practice location:
  • Phone: 607-363-2517
  • Fax:
Mailing address:
  • Phone: 607-865-2400
  • Fax: 607-865-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104763
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: