Provider Demographics
NPI:1831221282
Name:COLLINS, SUSAN MARIE (RPA-C, ATC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPA-C, ATC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:FEDKIW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C, ATC
Mailing Address - Street 1:7162 SARATOGA WATERS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7758
Mailing Address - Country:US
Mailing Address - Phone:561-512-9446
Mailing Address - Fax:
Practice Address - Street 1:7240 7TH PL N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3801
Practice Address - Country:US
Practice Address - Phone:561-969-6663
Practice Address - Fax:561-969-7760
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103028363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical