Provider Demographics
NPI:1396830998
Name:COLLINS, MARY LETA (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LETA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228
Mailing Address - Country:US
Mailing Address - Phone:931-526-5777
Mailing Address - Fax:931-526-5207
Practice Address - Street 1:120 WALNUT COMMONS LN
Practice Address - Street 2:SUITE C
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-6035
Practice Address - Country:US
Practice Address - Phone:931-526-5777
Practice Address - Fax:931-526-9749
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000005798363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3343249Medicaid
TN3343249Medicaid
TNP48061Medicare UPIN