Provider Demographics
NPI:1790866119
Name:COLLINS, CHERYL C (CNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:C
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SPRINGSIDE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4530
Mailing Address - Country:US
Mailing Address - Phone:330-666-9544
Mailing Address - Fax:330-670-8569
Practice Address - Street 1:231 SPRINGSIDE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4530
Practice Address - Country:US
Practice Address - Phone:330-666-9544
Practice Address - Fax:330-670-8569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411054Medicaid
OHNP16752Medicare ID - Type Unspecified
OH2411054Medicaid