MEDICARE: LUCINDA WEEKS COLLINS A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	9321958	FL
2	363LF0000X	Family Nurse Practitioner	1-061131	AL
3	363LF0000X	Family Nurse Practitioner	RN280275	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y0042	OTHER	FL	BLUE CROSS
2	51051874	OTHER	AL	BC/BS OF ALABAMA

General Provider Information

NPI Number	:	1083688311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA WEEKS COLLINS A.R.N.P.

Provider Business Mailing Address
First Line	:	156 ALEX WHITE DR
Second Line	:
City	:	DALEVILLE
State	:	AL
Zip	:	36322-5326
Country	:	US
Telephone Number	:	334-709-4172
Fax Number	:

Provider Business Practice Location Address
First Line	:	5239 BROWN ST
Second Line	:
City	:	GRACEVILLE
State	:	FL
Zip	:	32440
Country	:	US
Telephone Number	:	850-360-4909
Fax Number	:	850-360-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	06/24/2022

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