Provider Demographics
NPI:1861499972
Name:COLLIER, MARK (FNP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1205 SAINT CHARLES AVE
Mailing Address - Street 2:SUITE 1304
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4356
Mailing Address - Country:US
Mailing Address - Phone:985-778-8293
Mailing Address - Fax:504-398-1030
Practice Address - Street 1:8200 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2607
Practice Address - Country:US
Practice Address - Phone:504-398-1100
Practice Address - Fax:504-398-1030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89346-3582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1575607Medicaid
LAP13502Medicare UPIN
LA4B547Medicare ID - Type Unspecified