Provider Demographics
NPI:1023566544
Name:COGGINS, JULIE TAYLOR (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:TAYLOR
Last Name:COGGINS
Suffix:
Gender:F
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:910-572-2309
Mailing Address - Fax:910-572-3655
Practice Address - Street 1:835 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-8682
Practice Address - Country:US
Practice Address - Phone:910-572-2309
Practice Address - Fax:910-572-3655
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023566544Medicaid
NCNCU961AMedicare PIN