Provider Demographics
NPI:1972327922
Name:BENTLEY, COLLIN TAYLOR (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:TAYLOR
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8442 FARRAH LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3314
Mailing Address - Country:US
Mailing Address - Phone:573-318-6565
Mailing Address - Fax:
Practice Address - Street 1:4100 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2502
Practice Address - Country:US
Practice Address - Phone:901-213-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily