Provider Demographics
NPI:1225110679
Name:COLLINS, CORY HUTSON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CORY
Middle Name:HUTSON
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2631 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0588
Mailing Address - Country:US
Mailing Address - Phone:850-877-8539
Mailing Address - Fax:850-877-6674
Practice Address - Street 1:2631 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0588
Practice Address - Country:US
Practice Address - Phone:850-877-8539
Practice Address - Fax:850-877-6674
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37483OtherBLUE CROSS BLUE SHIELD
FL307822100Medicaid
FL307822100Medicaid