Individual
LATASHA COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-3631
(601) 200-0159
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(601) 200-3631
(225) 765-4278
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
871496
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06052845
—
MS
01
—
381429YKHV
MEDICARE
MS
01
—
P01874646
RAILROAD MEDICARE
MS
Enumeration date
11/04/2014
Last updated
07/10/2024
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