Provider Demographics
NPI:1174181846
Name:COLLINS, NIELA
Entity Type:Individual
Prefix:
First Name:NIELA
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 1:7203 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-1885
Mailing Address - Country:US
Mailing Address - Phone:323-547-6651
Mailing Address - Fax:772-595-0530
Practice Address - Street 1:7203 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-1885
Practice Address - Country:US
Practice Address - Phone:323-547-6651
Practice Address - Fax:772-595-0530
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician