Provider Demographics
NPI:1922509520
Name:COLLIE, JACLYN RAE (CRNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:RAE
Last Name:COLLIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:629-235-9745
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:3625 S HICKORY ST STE 102
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-4590
Practice Address - Country:US
Practice Address - Phone:251-677-6800
Practice Address - Fax:251-677-6801
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily