MEDICARE: MELISSA ANNE COLLINS FNP-C

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	201768	NC

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	:	1164496956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE COLLINS FNP-C

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-341-3321

Provider Business Practice Location Address
First Line	:	8108B MARKET ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-9386
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-251-8824

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	08/05/2014

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