Provider Demographics
NPI:1437162690
Name:COLLINS, NATIVEL J (CFNP)
Entity Type:Individual
Prefix:
First Name:NATIVEL
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 GLOSTER CREEK VLG
Mailing Address - Street 2:SUITE H9
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4600
Mailing Address - Country:US
Mailing Address - Phone:662-842-0184
Mailing Address - Fax:662-842-0187
Practice Address - Street 1:499 GLOSTER CREEK VLG
Practice Address - Street 2:SUITE H9
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:662-842-0184
Practice Address - Fax:662-842-0187
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02697OtherMEDICARE GROUP
MSC02697OtherMEDICARE GROUP