Provider Demographics
NPI:1457501207
Name:COLLARD, JACQUELINE FAITH (RN, PNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FAITH
Last Name:COLLARD
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1800
Mailing Address - Country:US
Mailing Address - Phone:716-285-0045
Mailing Address - Fax:
Practice Address - Street 1:501 10TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1800
Practice Address - Country:US
Practice Address - Phone:716-285-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520157163W00000X
NYF381666363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse