MEDICARE: COLLIER SURGICAL SERVICES LLC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1417888710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER SURGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	11629 GWYNFORD LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7253
Country	:	US
Telephone Number	:	904-613-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	11629 GWYNFORD LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7253
Country	:	US
Telephone Number	:	904-613-7158
Fax Number	:

Authorized Official
Title or Position	:	FIRST ASSISTANT
Name	:	MR. SCOTT R COLLIER
Credential	:	CSFA
Telephone Number	:	904-613-7158

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/27/2026

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