Healthcare Provider Details

I. General information

NPI: 1154372076
Provider Name (Legal Business Name): ANGELA LYN COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LYN WILSON PA-C

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 712
HERMITAGE TN
37076
US

IV. Provider business mailing address

5651 FRIST BLVD SUITE 712
HERMITAGE TN
37076-2054
US

V. Phone/Fax

Practice location:
  • Phone: 615-872-9966
  • Fax: 615-872-9967
Mailing address:
  • Phone: 615-872-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000001224
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: