MEDICARE: ERICA N COLLINS CRNA

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	163W00000X	Registered Nurse	158640	NC
2	367500000X	Certified Registered Nurse Anesthetist	55246	NC
3	367500000X	Certified Registered Nurse Anesthetist	4497	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01042933	OTHER	NC	RAILROAD MEDICARE
7	P00352737	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10065584	OTHER	GA	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1780609198	OTHER	NC	TRICARE

General Provider Information

NPI Number	:	1780609198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA N COLLINS CRNA

Provider Business Mailing Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

Provider Business Practice Location Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/20/2021

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Directions to “ ERICA N COLLINS CRNA” Practice Location

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