Provider Demographics
NPI:1043461627
Name:COFFY-MCCORMICK, CAREN MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:MICHELLE
Last Name:COFFY-MCCORMICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 CARTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5846
Mailing Address - Country:US
Mailing Address - Phone:302-449-0710
Mailing Address - Fax:302-449-1770
Practice Address - Street 1:292 CARTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-449-0710
Practice Address - Fax:302-449-1770
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000176364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult