Provider Demographics
NPI:1407531825
Name:COFFEY, EMILY ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:COFFEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PAVILICA RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1106
Mailing Address - Country:US
Mailing Address - Phone:757-298-5110
Mailing Address - Fax:
Practice Address - Street 1:3535 US HIGHWAY 1 STE 463A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5974
Practice Address - Country:US
Practice Address - Phone:609-445-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14865000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine