Provider Demographics
NPI:1568711794
Name:COLLINS, JENNIFER ELIZABETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:COLLINS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:29409 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1137
Mailing Address - Country:US
Mailing Address - Phone:310-832-4225
Mailing Address - Fax:310-831-4860
Practice Address - Street 1:29409 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1137
Practice Address - Country:US
Practice Address - Phone:310-832-4225
Practice Address - Fax:310-831-4860
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA22504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant