Provider Demographics
NPI:1679703557
Name:COLLINS, LAURA LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SUSSEX CIR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1165
Mailing Address - Country:US
Mailing Address - Phone:661-331-7827
Mailing Address - Fax:
Practice Address - Street 1:815 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1365
Practice Address - Country:US
Practice Address - Phone:661-635-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily