Provider Demographics
NPI:1851383244
Name:COLLMAN, NICOLE LEE (RN, NP, CNS)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LEE
Last Name:COLLMAN
Suffix:
Gender:F
Credentials:RN, NP, CNS
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:LEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:STE. M195
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122
Mailing Address - Country:US
Mailing Address - Phone:415-353-2873
Mailing Address - Fax:415-353-2528
Practice Address - Street 1:1779 W YOSEMITE AVE
Practice Address - Street 2:YOSEMITE BUILDING, SUITE 200
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5112
Practice Address - Country:US
Practice Address - Phone:209-825-2485
Practice Address - Fax:209-825-2499
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNS 2249364SX0106X
CANP15718363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health