From what I understand, acme clients talk to the LE API and create an "account" (whatever that means) during first setup. I've done this once for a domain. Now I want to do it again for a different domain on another server.
Can I supply this setup process with the same email address I used for the first domain or will this cause a collision on the LE side? Are "accounts" per-domain or per-email?
Neither, accounts are "per-account key". An ACME client generates a public/private key pair (RSA or ECDSA I believe, weirdly enough RFC 8555 does not specify any account key limitations) and that key is used by the ACME server (the public key to be exact) to identify the account.
Note that it's very much possible to register multiple certificates from just a single account. Even so, Let's Encrypt recommends even for larger hosting providers to use a single account: Integration Guide - Let's Encrypt