Provider Demographics
NPI:1629631361
Name:COLLINS, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
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 1:5601 NATOMAS BLVD APT 3313
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2257
Mailing Address - Country:US
Mailing Address - Phone:916-559-1503
Mailing Address - Fax:
Practice Address - Street 1:8801 FOLSOM BLVD STE 195
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3231
Practice Address - Country:US
Practice Address - Phone:916-539-9195
Practice Address - Fax:510-251-8120
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician