1699083345 NPI number — MS. ERIN NICOLE COLLINS P.A.-C

Table of content: MS. ERIN NICOLE COLLINS P.A.-C (NPI 1699083345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699083345 NPI number — MS. ERIN NICOLE COLLINS P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
ERIN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699083345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2323 W ROSE GARDEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-521-6252
Provider Business Mailing Address Fax Number:
623-842-5640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 N SCOTTSDALE RD STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-5649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-425-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 4695 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 562434 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".