Provider Demographics
NPI:1942887195
Name:COLLINS, JEREMIAH DORRINGTON IV
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:DORRINGTON
Last Name:COLLINS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 SW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6408
Mailing Address - Country:US
Mailing Address - Phone:727-599-6926
Mailing Address - Fax:
Practice Address - Street 1:7026 SW 46TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6408
Practice Address - Country:US
Practice Address - Phone:727-599-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist