Provider Demographics
NPI:1083688311
Name:COLLINS, LUCINDA WEEKS (ARNP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:WEEKS
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ALEX WHITE DR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-5326
Mailing Address - Country:US
Mailing Address - Phone:334-709-4172
Mailing Address - Fax:
Practice Address - Street 1:5239 BROWN ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440
Practice Address - Country:US
Practice Address - Phone:850-360-4909
Practice Address - Fax:850-360-4911
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9321958363L00000X
AL1-061131363LF0000X
GARN280275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0042OtherBLUE CROSS
AL51051874OtherBC/BS OF ALABAMA
ALP00440758Medicare PIN
AL051558624Medicare PIN
AL51051874OtherBC/BS OF ALABAMA
ALS96476Medicare UPIN