Provider Demographics
NPI:1679759880
Name:COLLINS, KENNETH CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHRISTOPHER
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-767-4755
Mailing Address - Fax:727-767-4951
Practice Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:SUITE 108
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1547
Practice Address - Country:US
Practice Address - Phone:727-767-4755
Practice Address - Fax:727-767-4951
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104475364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics