Terence Roger Collins, MD

Individual provider Active NPI Family Medicine Physician · Yulee, FL

NPI 1720097660 · NPPES record last updated Feb 4, 2013

Key facts

NPI
1720097660
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
ME39441 (FL)
Practice address
86014 Pages Dairy Rd
Yulee, FL 32097-5203
Phone
(904) 548-1880
Fax
(904) 225-0850
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME39441FLMDFamily Medicine Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME39441 FL Yes

Addresses

Primary practice location

86014 Pages Dairy Rd
Yulee, FL 32097-5203

Mailing address

PO Box 517
Fernandina Beach, FL 32035-0517
Phone (904) 548-1800

Other identifiers

IdentifierTypeStateIssuer
271664000MedicaidFL

Other providers in Yulee, FL

All providers in Yulee, FL · Family Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.