Provider Demographics
NPI:1083115356
Name:COLLINS, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
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 1:2318 IVANHOE LN
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6212
Mailing Address - Country:US
Mailing Address - Phone:325-733-4485
Mailing Address - Fax:
Practice Address - Street 1:2318 IVANHOE LANE
Practice Address - Street 2:IVANHOE LN
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-7960
Practice Address - Country:US
Practice Address - Phone:325-733-4485
Practice Address - Fax:325-733-4485
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX099170164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse