MEDICARE: MRS. SHIRLEY ANN COLLIER 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	APN14873	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN0000109336	OTHER	TN	REGISTERED NURSE
2	APN14873	OTHER	TN	CAPN

General Provider Information

NPI Number	:	1780816413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY ANN COLLIER APRN

Provider Business Mailing Address
First Line	:	557 W PARK PL
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-2027
Country	:	US
Telephone Number	:	731-989-1007
Fax Number	:	731-989-0704

Provider Business Practice Location Address
First Line	:	557 W PARK PL
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-2027
Country	:	US
Telephone Number	:	731-989-1007
Fax Number	:	731-989-0704

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

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	05/19/2016

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