Provider Demographics
NPI:1548362106
Name:COLLINS, JEANETTE JENNIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:JENNIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1025
Mailing Address - Country:US
Mailing Address - Phone:914-693-6208
Mailing Address - Fax:
Practice Address - Street 1:67 WOOD AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1025
Practice Address - Country:US
Practice Address - Phone:914-693-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303826-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner