Healthcare Provider Details

I. General information

NPI: 1487363123
Provider Name (Legal Business Name): LINDA L COLLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE STE 100
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-5320
  • Fax: 585-442-5526
Mailing address:
  • Phone: 585-922-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: