Provider Demographics
NPI:1821320185
Name:HERBST-COLLINS, ELIZABETH ANNE (PA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HERBST-COLLINS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:3401 W. SUNFLOWER AVE.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-619-8777
Mailing Address - Fax:714-619-8770
Practice Address - Street 1:3401 W. SUNFLOWER AVE.
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:714-619-8770
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 14370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant