Provider Demographics
NPI:1114167657
Name:JO ANN COLLINSLLC
Entity Type:Organization
Organization Name:JO ANN COLLINSLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NURSE ANESTHETIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:301-248-7078
Mailing Address - Street 1:3103 CALYDON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1409
Mailing Address - Country:US
Mailing Address - Phone:301-248-7078
Mailing Address - Fax:301-248-7078
Practice Address - Street 1:3103 CALYDON CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1409
Practice Address - Country:US
Practice Address - Phone:301-248-7078
Practice Address - Fax:301-248-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27885207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty