Provider Demographics
NPI:1821617556
Name:COLLINS, JOSANA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSANA
Middle Name:ELIZABETH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7630
Mailing Address - Country:US
Mailing Address - Phone:909-226-1722
Mailing Address - Fax:
Practice Address - Street 1:5849 CRESCENT LN
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7630
Practice Address - Country:US
Practice Address - Phone:909-226-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant