Provider Demographics
NPI:1225628951
Name:COLLINS, LAUREL (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-2070
Mailing Address - Country:US
Mailing Address - Phone:361-382-2024
Mailing Address - Fax:855-606-6314
Practice Address - Street 1:408 N GIRAUD
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-3113
Practice Address - Country:US
Practice Address - Phone:830-879-2279
Practice Address - Fax:830-879-2235
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA14171OtherTEXAS MEDICAL BOARD