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General NPI Number Information
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NPI Number | 1528801172
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Entity Type | Individual
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Provider Name | TIANA SAN NICOLAS COLLINS
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Gender | Female
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Dates
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Enumeration Date | 06/13/2024
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 6820 SOUTHPOINT PKWY STE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6277
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Country | US
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Telephone | 888-754-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 HODGES BLVD APT 511
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City | JACKSONVILLE
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State | FL
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Zip | 32224-3036
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Country | US
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Telephone | 904-581-2256
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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