Provider Demographics
NPI:1437645892
Name:COLLINS - VAZQUEZ ATECAS, LEIGH ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:COLLINS - VAZQUEZ ATECAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NE ROMANCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-8315
Mailing Address - Country:US
Mailing Address - Phone:360-277-2950
Mailing Address - Fax:
Practice Address - Street 1:217 N BOONE ST STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-7612
Practice Address - Country:US
Practice Address - Phone:360-637-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60872229363L00000X, 363LP2300X
AR213554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1437645892Medicaid
WA83-1064079Medicaid