Provider Demographics
NPI:1508967159
Name:COLLINS, DEBRA COBB (APN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:COBB
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLEN ALLAN CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3702
Mailing Address - Country:US
Mailing Address - Phone:901-854-7118
Mailing Address - Fax:
Practice Address - Street 1:5823 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MICHIE
Practice Address - State:TN
Practice Address - Zip Code:38357-5175
Practice Address - Country:US
Practice Address - Phone:901-377-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN55526163W00000X
TNAPN5664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731594Medicaid
TN3731594Medicaid
S77386Medicare UPIN