Individual provider Active NPI

Jackie L Collins, CNP

  • Family Nurse Practitioner
  • Waconia, MN
National Provider Identifier
1023086568
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R128366-4 Issued in MN
Practice address
875 E Main St
Waconia, MN 55387-1081
Phone
(866) 389-2727
NPI assigned
Mar 10, 2006
Last updated
Jul 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R128366-4 MN Primary

Addresses

Primary practice location

875 E Main St
Waconia, MN 55387-1081

Mailing address

6725 York Ave S Apt 457
Edina, MN 55435-3232
Phone (952) 221-0950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100512000344 MN Practitioner - Nurse Practitioner 5991833949 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3225MNMDMental Health Counselor
R128366-4MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carris Health LLC CurrentSince May 8, 2019 Accepting new patients
Minuteclinic Diagnostic of Minnesota, P.a. Family CurrentSince Jul 10, 2025 Accepting new patients
Carris Health LLC CurrentSince May 8, 2019 Accepting new patients
Minnesota Pathologists Chartered Current Accepting new patients
Minnesota Oncology Hematology, PA PastSince Jan 12, 2020 Accepting new patients
Minnesota Oncology Hematology, PA Past Accepting new patients

Locations

612 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-3242

1500 109th Ave NE
Minneapolis, MN 55449
Phone (763) 354-1000

875 E Main St
Waconia, MN 55387
Phone (952) 442-9333

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

1 Cvs Dr
#2295
Woonsocket, RI 02895
Phone (401) 770-8043

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1023086568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6725 YORK AVE S APT 457",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554353232",
            "telephone_number": "952-221-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 E MAIN ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871081",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "JACKIE",
        "middle_name": "L",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R128366-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.