Provider Demographics
NPI:1780980029
Name:COLLINS, ERICA ALLESANDRA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ALLESANDRA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ALLESANDRA
Other - Last Name:STERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:
Practice Address - Street 1:3604 LIVE OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6169
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6985
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120086363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP120086OtherLICENSE
MS04177396Medicaid
MS04177396Medicaid