Provider Demographics
NPI:1972072882
Name:COLLINS, JENNIFER J (APN, CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26141 E WILDLIFE DR
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-9232
Mailing Address - Country:US
Mailing Address - Phone:309-532-3103
Mailing Address - Fax:
Practice Address - Street 1:6 WESTPORT CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8233
Practice Address - Country:US
Practice Address - Phone:309-722-4020
Practice Address - Fax:309-740-4440
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018406176B00000X
IL209018406367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife