Provider Demographics
NPI:1518223247
Name:COLLINS, VERONICA
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:COLLINS
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 1:4646 POPLAR AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4432
Mailing Address - Country:US
Mailing Address - Phone:901-474-7166
Mailing Address - Fax:901-474-7166
Practice Address - Street 1:4646 POPLAR AVE STE 213
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4432
Practice Address - Country:US
Practice Address - Phone:901-474-7166
Practice Address - Fax:901-474-7166
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 3747A0650X, 376J00000X, 376K00000X, 376K00000X
TN1000000010608253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445656Medicaid