Provider Demographics
NPI:1477890762
Name:KOLLIE-JONES, TEINIDA L (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:TEINIDA
Middle Name:L
Last Name:KOLLIE-JONES
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 GLEN AVON RD
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1414
Mailing Address - Country:US
Mailing Address - Phone:484-888-1622
Mailing Address - Fax:
Practice Address - Street 1:1130 GLEN AVON RD
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1414
Practice Address - Country:US
Practice Address - Phone:484-888-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN61862163W00000X
PARN618962372600000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide