Provider Demographics
NPI:1235135443
Name:COLLINS, GINA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LYNN
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3200
Mailing Address - Fax:336-832-3201
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-832-3200
Practice Address - Fax:336-832-3201
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101714363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2745738AMedicare PIN
NCS52525Medicare UPIN