Healthcare Provider Details

I. General information

NPI: 1396837654
Provider Name (Legal Business Name): JAYNE D. COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TOWNE AVE
PLAINFIELD VT
05667-9425
US

IV. Provider business mailing address

PO BOX 320
PLAINFIELD VT
05667-0320
US

V. Phone/Fax

Practice location:
  • Phone: 802-454-8336
  • Fax:
Mailing address:
  • Phone: 802-454-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055-0031172
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: