Provider Demographics
NPI:1962090753
Name:COLLINS, NIKKI (RN)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:568 WILL FUNDERBURKE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:GA
Mailing Address - Zip Code:30421-2970
Mailing Address - Country:US
Mailing Address - Phone:912-288-3778
Mailing Address - Fax:
Practice Address - Street 1:568 WILL FUNDERBURKE RD
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:GA
Practice Address - Zip Code:30421-2970
Practice Address - Country:US
Practice Address - Phone:912-288-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA256722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse