Provider Demographics
NPI:1255926937
Name:COLLINS, TIELESHA M
Entity type:Individual
Prefix:
First Name:TIELESHA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 IRISH BEND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2630
Mailing Address - Country:US
Mailing Address - Phone:817-905-0812
Mailing Address - Fax:682-255-5429
Practice Address - Street 1:8808 IRISH BEND DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2630
Practice Address - Country:US
Practice Address - Phone:817-905-0812
Practice Address - Fax:682-255-5429
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home