Provider Demographics
NPI:1619503331
Name:COLLINS, CHELSEA (RN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 BOAT CLUB RD APT 512
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3618
Mailing Address - Country:US
Mailing Address - Phone:214-326-5057
Mailing Address - Fax:
Practice Address - Street 1:8301 BOAT CLUB RD APT 512
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3618
Practice Address - Country:US
Practice Address - Phone:214-326-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse