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General NPI Number Information
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NPI Number | 1265670384
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Entity Type | Individual
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Provider Name | LINDA MARIE COLLIFLOWER RNC,NP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 12140 NEW YORK RANCH RD
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City | JACKSON
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State | CA
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Zip | 95642-9407
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Country | US
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Telephone | 209-257-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 817 COURT ST #8
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City | JACKSON
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State | CA
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Zip | 95642-2156
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Country | US
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Telephone | 209-223-1031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1622
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1622
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License Number State | CA
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