MEDICARE: MRS. LATEEFAH A. COLLINGWOOD

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	AP6463	AZ

General Provider Information

NPI Number	:	1497481881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATEEFAH A. COLLINGWOOD

Provider Business Mailing Address
First Line	:	9748 E ROCK RIDGE CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-7907
Country	:	US
Telephone Number	:	520-247-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	9748 E ROCK RIDGE CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-7907
Country	:	US
Telephone Number	:	520-247-7886
Fax Number	:

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

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “ MRS. LATEEFAH A. COLLINGWOOD ” Practice Location

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