Provider Demographics
NPI:1497481881
Name:COLLINGWOOD, LATEEFAH A
Entity Type:Individual
Prefix:MRS
First Name:LATEEFAH
Middle Name:A
Last Name:COLLINGWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9748 E ROCK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-7907
Mailing Address - Country:US
Mailing Address - Phone:520-247-7886
Mailing Address - Fax:
Practice Address - Street 1:9748 E ROCK RIDGE CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-7907
Practice Address - Country:US
Practice Address - Phone:520-247-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP6463363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care