Healthcare Provider Details

I. General information

NPI: 1174589105
Provider Name (Legal Business Name): SEAN P COLLINS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10464 S REDWOOD RD
SOUTH JORDAN UT
84095-8501
US

IV. Provider business mailing address

PO BOX 1000
DRAPER UT
84020-1000
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax:
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number312145-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number312145-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: