Provider Demographics
NPI:1134488919
Name:COLLINS, CECELIA ANNE (RD, RN)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:ANNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 CALLE ARRAGON AVENUE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-791-8586
Mailing Address - Fax:
Practice Address - Street 1:9215 CALLE ARRAGON AVENUE
Practice Address - Street 2:UNIT 205
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-791-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5542133V00000X
FLRN9259740163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator