Provider Demographics
NPI:1750536975
Name:COLLINS, ANDREA WHITE (CRNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:WHITE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MARY ANN LN
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-4201
Mailing Address - Country:US
Mailing Address - Phone:205-467-7502
Mailing Address - Fax:
Practice Address - Street 1:1020 26TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2412
Practice Address - Country:US
Practice Address - Phone:205-332-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054515363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117859OtherBCBS
AL129200Medicaid
AL129199Medicaid
AL051117857OtherBCBS
AL051117858OtherBCBS
MS01985718Medicaid
AL129198Medicaid
AL129198Medicaid