Provider Demographics
NPI:1497786099
Name:COLLINS, THOMAS JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:COLLINS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:44TH CST/WMD BLDG# 4398
Mailing Address - Street 2:CAMP BLANDING JOINT TRAINING CENTER
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091
Mailing Address - Country:US
Mailing Address - Phone:904-682-2419
Mailing Address - Fax:904-682-3230
Practice Address - Street 1:44TH CST/WMD BLDG# 4398
Practice Address - Street 2:CAMP BLANDING JOINT TRAINING CENTER
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091
Practice Address - Country:US
Practice Address - Phone:904-682-2419
Practice Address - Fax:904-682-3230
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 3726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE38012Medicaid
FLE38012Medicaid