Provider Demographics
NPI:1790064442
Name:COLLINS, CARLA BROWN
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:BROWN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ELINOR
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1020 BROADWAY
Mailing Address - Street 2:SOMERVILLE FAMILY PRACTICE
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-628-2160
Mailing Address - Fax:617-628-8237
Practice Address - Street 1:1020 BROADWAY
Practice Address - Street 2:SOMERVILLE FAMILY PRACTICE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1819
Practice Address - Country:US
Practice Address - Phone:617-628-2160
Practice Address - Fax:617-628-8237
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267974163WP2201X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care