Provider Demographics
NPI:1710567540
Name:COLLIER, JESSE (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 29650, DEPT # 880579
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:480-616-0016
Mailing Address - Fax:480-626-2690
Practice Address - Street 1:1919 S SHILOH RD STE 400
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8211
Practice Address - Country:US
Practice Address - Phone:469-320-1267
Practice Address - Fax:469-320-1268
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily