Provider Demographics
NPI:1255746095
Name:COLLINS, RACHEL QUINN (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:QUINN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547
Mailing Address - Country:US
Mailing Address - Phone:970-673-1155
Mailing Address - Fax:970-673-4747
Practice Address - Street 1:6801 W. 20TH SUITE 208
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80651
Practice Address - Country:US
Practice Address - Phone:970-673-1155
Practice Address - Fax:970-673-4747
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3326-23363AM0700X
COPA0004264363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255746095Medicaid