Provider Demographics
NPI:1356090625
Name:COLLINS, LISA MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 USA SOUTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0002
Mailing Address - Country:US
Mailing Address - Phone:251-460-7151
Mailing Address - Fax:251-414-8227
Practice Address - Street 1:5870 USA SOUTH DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-4402
Practice Address - Country:US
Practice Address - Phone:251-460-7151
Practice Address - Fax:251-414-8227
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018815363LP0808X
AL1-125768363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health