MEDICARE: CAROL L 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	363LF0000X	Family Nurse Practitioner	AP30005619	WA
2	363LF0000X	Family Nurse Practitioner	AP4970	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104859875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L COLLINS A.R.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-480-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	20414 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3250
Country	:	US
Telephone Number	:	602-849-0115
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/07/2024

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