Thomas Joseph Collins, PA-C
Individual provider Active NPI Physician Assistant · Starke, FL
NPI 1497786099 · NPPES record last updated Dec 1, 2010
Key facts
- NPI
- 1497786099
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA 3726 (FL)
- Practice address
- 44TH CST/WMD BLDG# 4398
Camp Blanding Joint Training Center
Starke, FL 32091 - Phone
- (904) 682-2419
- Fax
- (904) 682-3230
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140506002000 | FL | Order and Referring Only - Physician Assistant | 6608891502 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 3726 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osprey Emergency Physicians LLC | Past | Accepting new patients | |
| Florida Em-I Medical Services PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 3726 | FL | Yes |
Addresses
Primary practice location
44TH CST/WMD BLDG# 4398
Camp Blanding Joint Training Center
Starke, FL 32091
Mailing address
44TH CST/WMD BLDG# 4398
Camp Blanding Joint Training Center
Starke, FL 32091
Phone (904) 682-2419
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E38012 | Medicaid | FL |
Other providers in Starke, FL
- Childrens Home Society
- Jacki Shehan Clark
- Tricia Lawson Clark
- Angela Coggins-Anderson
- Susan Dianne Colby
- Shecara Coney
- County of Bradford
- Kristina Libby Crawford
- Creating Communication, Inc.
- Talisha H Cunningham
All providers in Starke, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.