Provider Demographics
NPI:1124775028
Name:COLLIER, JACQUELINE SHEA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SHEA
Last Name:COLLIER
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4133
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0010
Mailing Address - Country:US
Mailing Address - Phone:770-354-1699
Mailing Address - Fax:
Practice Address - Street 1:413 PARKBROOK WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5736
Practice Address - Country:US
Practice Address - Phone:770-354-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239032163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant