Provider Demographics
NPI:1720061815
Name:COLLINS, KIMBERLY A (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 EVERGREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2945
Mailing Address - Country:US
Mailing Address - Phone:813-907-9398
Mailing Address - Fax:
Practice Address - Street 1:TAMPA GENERAL HOSPITAL
Practice Address - Street 2:ONE DAVIS BLVD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33601
Practice Address - Country:US
Practice Address - Phone:813-844-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80883207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44069Medicare UPIN