Provider Demographics
NPI:1881327831
Name:COLLINS, TENNILLE FAYETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:FAYETTE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TENNILLE
Other - Middle Name:FAYETTE
Other - Last Name:BEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-3601
Mailing Address - Country:US
Mailing Address - Phone:386-956-3943
Mailing Address - Fax:
Practice Address - Street 1:555 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:LAKE HELEN
Practice Address - State:FL
Practice Address - Zip Code:32744-3601
Practice Address - Country:US
Practice Address - Phone:386-956-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist