Provider Demographics
NPI:1003609488
Name:COLLINS, JACKQUEL ANESHIA
Entity type:Individual
Prefix:
First Name:JACKQUEL
Middle Name:ANESHIA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18103 CLOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4435
Mailing Address - Country:US
Mailing Address - Phone:318-820-5026
Mailing Address - Fax:
Practice Address - Street 1:18103 CLOVER PARK DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4435
Practice Address - Country:US
Practice Address - Phone:318-820-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF05250056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily