Provider Demographics
NPI:1619472172
Name:COLLINS, JOANNE
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
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 1:404 SE CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5378
Mailing Address - Country:US
Mailing Address - Phone:386-288-6291
Mailing Address - Fax:386-243-8545
Practice Address - Street 1:404 SE CHURCH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5378
Practice Address - Country:US
Practice Address - Phone:386-288-6291
Practice Address - Fax:386-243-8545
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL464222934347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker