MEDICARE: MARTIN CHANDLER COLLINS APRN

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	259295	AZ
2	363L00000X	Nurse Practitioner	259295	AZ

General Provider Information

NPI Number	:	1427832468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN CHANDLER COLLINS APRN

Provider Business Mailing Address
First Line	:	10410 N 9TH ST UNIT 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-8513
Country	:	US
Telephone Number	:	256-267-6897
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 N 9TH ST UNIT 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-8513
Country	:	US
Telephone Number	:	256-267-6897
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	03/10/2026

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