Provider Demographics
NPI:1821333162
Name:COLLINS, BEVERLY ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 RICKERHILL LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1684
Mailing Address - Country:US
Mailing Address - Phone:951-265-3677
Mailing Address - Fax:
Practice Address - Street 1:23811 WASHINGTON AVE
Practice Address - Street 2:C110-265
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-265-3677
Practice Address - Fax:951-239-0110
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3109363LW0102X, 363L00000X, 363LP2300X
TXAP123876363LW0102X, 363LP2300X
CA159780363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner