ELIZABETH S COLLIE-MICKENS


Address: 2862 Nw Suwannee Valley Rd, Lake City, FL 32055-5603
Phone: 3863655221

ELIZABETH S COLLIE-MICKENS (NPI# 1356578348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1356578348
Entity Type Individual
Full Name ELIZABETH S COLLIE-MICKENS
Other Name ELIZABETH S COLLIE
Credential ARNP
Practice Address 2862 Nw Suwannee Valley Rd
Lake City
FL 32055-5603
Practice Telephone 3863655221
Mailing Telephone 3863655221
Enumeration Date 2009-06-17
Last Update Date 2012-01-18
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LA2100X Nurse Practitioner
Specialization: Acute Care
ARNP9203771 FL Physician Assistants & Advanced Practice Nursing Providers
Y 363LG0600X Nurse Practitioner
Specialization: Gerontology
ARNP9203771 FL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 2862 NW SUWANNEE VALLEY RD
City LAKE CITY
State FL
Zip Code 32055-5603

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Taxonomy Information

Taxonomy Code 363LG0600X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Gerontology

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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Competitor

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City LAKE CITY
Zip Code 32055

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Dataset Information

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.

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