Provider Demographics
NPI:1417032368
Name:COYNE, BRIDGET MARY (MSN CRNP)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:MARY
Last Name:COYNE
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3920 NORTH UNION BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-598-8155
Mailing Address - Fax:719-598-3188
Practice Address - Street 1:3920 NORTH UNION BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-598-8155
Practice Address - Fax:719-598-3188
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0100073-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM345952Medicaid
NM345952Medicaid