Provider Demographics
NPI:1245871334
Name:COLLINS, TERRELL AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:AMANDA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERRELL
Other - Middle Name:AMANDA
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1297 W LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3423
Mailing Address - Country:US
Mailing Address - Phone:856-507-8548
Mailing Address - Fax:
Practice Address - Street 1:1297 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3423
Practice Address - Country:US
Practice Address - Phone:856-507-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical