Provider Demographics
NPI:1053830562
Name:COLLINS, MASON BERYL (FNP)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:BERYL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3812
Mailing Address - Country:US
Mailing Address - Phone:325-777-0737
Mailing Address - Fax:617-604-2536
Practice Address - Street 1:2021 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3812
Practice Address - Country:US
Practice Address - Phone:325-777-0737
Practice Address - Fax:617-604-2536
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily