Provider Demographics
NPI:1265670384
Name:COLLIFLOWER, LINDA MARIE (RNC,NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:COLLIFLOWER
Suffix:
Gender:F
Credentials:RNC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COURT ST
Mailing Address - Street 2:#8
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2156
Mailing Address - Country:US
Mailing Address - Phone:209-223-1031
Mailing Address - Fax:
Practice Address - Street 1:12140 NEW YORK RANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9407
Practice Address - Country:US
Practice Address - Phone:209-257-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1622363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health