Provider Demographics
NPI:1265823637
Name:THOMAS, COLLIN (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42440 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2403
Mailing Address - Country:US
Mailing Address - Phone:985-542-4950
Mailing Address - Fax:985-318-6400
Practice Address - Street 1:42440 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2403
Practice Address - Country:US
Practice Address - Phone:985-542-4950
Practice Address - Fax:985-318-6400
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08199363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2383001Medicaid