=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942705413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLINS TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2018
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 4TH ST NW
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32052-5953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-288-6291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 SE CHURCH AVE
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32025-5378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-288-6291
-----------------------------------------------------
Fax | 386-243-8545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JOANNE D COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-288-6291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------