Healthcare Provider Details

I. General information

NPI: 1508967159
Provider Name (Legal Business Name): DEBRA COBB COLLINS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 HIGHWAY 22
MICHIE TN
38357-5175
US

IV. Provider business mailing address

670 GLEN ALLAN CV
COLLIERVILLE TN
38017-3702
US

V. Phone/Fax

Practice location:
  • Phone: 901-377-1011
  • Fax:
Mailing address:
  • Phone: 901-854-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN55526
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: