Provider Demographics
NPI:1336108117
Name:WHITE-COLLINS, ANDREA M (CPNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:WHITE-COLLINS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0920
Practice Address - Fax:602-933-2492
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0225363LP0222X
AZAP6979363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ728082Medicaid
AZZ152978Medicare PIN
AZ728082Medicaid