JACKIE L COLLINS (NPI# 1023086568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023086568 |
| Entity Type | Individual |
| Full Name | JACKIE L COLLINS |
| Credential | CNP |
| Practice Address |
2805 Campus Dr Ste 105 Plymouth MN 55441-2677 |
| Mailing Address |
2550 University Ave W Ste 110n Saint Paul MN 55114-2001 |
| Practice Telephone | 7635197440 |
| Practice Fax Number | 7635197445 |
| Mailing Telephone | 6516025311 |
| Mailing Fax Number | 6512226786 |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2019-06-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R128366-4 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | HEALTHPARTNERS | HP32641 | 01 |
| MD | 404934900 | 05 | |
| MN | UCARE MN | 151404 | 01 |
| MN | MEDICA | 0105787 | 01 |
| MN | AMERICA'S PPO | 1241627 | 01 |
| MN | BLUE CROSS BLUE SHIELD MN | 67B81CO | 01 |
| MN | 737611100 | 05 | |
| MN | PREFERREDONE | 1032598 | 01 |
| WI | 41184100 | 05 |
| Street Address |
2805 CAMPUS DR STE 105 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441-2677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932258472 | Joalle L Holmberg | Physician Assistant | 2805 Campus Dr Ste 105, Plymouth, MN 55441-2677 | 2007-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
| Find all providers in zip 55441 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477180826 | Stephanie Jordan | Nurse Practitioner | 22 Cranberry Rd, Plymouth, MA 02360-2857 | 2020-03-25 |
| 1710543863 | Kristen Marie Kubik | Nurse Practitioner | 13970 Oakland Ct, Plymouth, MI 48170-5292 | 2019-05-14 |
| 1679931505 | Hillary Costa | Nurse Practitioner | 45 Resnik Rd Ste 302, Plymouth, MA 02360-4883 | 2016-02-06 |
| 1811374747 | Jill Marie Geer | Nurse Practitioner | 510 W Adams St, Suite 150, Plymouth, IN 46563-1765 | 2015-04-29 |
| 1740677921 | Inner Banks Family Medicine | Nurse Practitioner | 543 Us Highway 64 W, Plymouth, NC 27962-2144 | 2015-04-24 |
| 1952706210 | Elizabeth Nelson-frazier | Nurse Practitioner | 50 Aldren Road, Plymouth, MA 02061-2711 | 2014-10-29 |
| 1902206899 | Kathleen E Steensma | Nurse Practitioner | 15700 37th Ave N. #110, Plymouth, MN 55446 | 2014-08-27 |
| 1730595943 | Nicole Lee | Nurse Practitioner | 10 Bay Cliff Cir, Plymouth, MA 02360-1458 | 2014-07-08 |
| 1700122579 | Renae Charlene Atkins | Nurse Practitioner | 2855 Miller Dr Ste 119, Plymouth, IN 46563-8091 | 2012-12-21 |
| 1396097069 | Kristin Lynn Spencer | Nurse Practitioner | 3007 Harbor Lane North, Park Nicollet Clinic Plymouth - Family Medicine, Plymouth, MN 55447 | 2012-10-05 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.