Provider Demographics
NPI:1528801172
Name:SAN NICOLAS COLLINS, TIANA
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:SAN NICOLAS COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:
Other - Last Name:SAN NICOLAS EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 HODGES BLVD APT 511
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3036
Mailing Address - Country:US
Mailing Address - Phone:904-581-2256
Mailing Address - Fax:
Practice Address - Street 1:6820 SOUTHPOINT PKWY STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6277
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician