Basic Information
| Provider Information | |||||||||
| NPI: | 1760416135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | ST FRANCIS MEDICAL CENTER | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | ST FRANCIS MEDICAL CENTER | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NN93251 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0098914 | 05 | NJ | MEDICAID |