Provider Demographics
NPI:1154372076
Name:COLLINS, ANGELA LYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LYN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:LYN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 712
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 712
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:615-872-9966
Practice Address - Fax:615-872-9967
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001224363A00000X
TN1224363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36635141Medicare PIN