Provider Demographics
NPI:1144373705
Name:COLLINS, EDWARD MICHAEL (APN)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 MOONLIGHT RIDGE ARC
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1639
Mailing Address - Country:US
Mailing Address - Phone:201-406-8786
Mailing Address - Fax:
Practice Address - Street 1:2550 SAMARITAN DR STE 121
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1170
Practice Address - Country:US
Practice Address - Phone:575-522-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76576363LA2100X
NJ26NO111105163WE0003X
NJ26NJ00128900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0144843Medicaid
NJ0144843Medicaid
NJ111652B8AMedicare PIN