Provider Demographics
NPI:1437554706
Name:COFFEY, NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GRAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:702 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1253
Mailing Address - Country:US
Mailing Address - Phone:610-363-1330
Mailing Address - Fax:610-524-8574
Practice Address - Street 1:702 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1253
Practice Address - Country:US
Practice Address - Phone:610-363-1330
Practice Address - Fax:610-524-8574
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020829363LF0000X
CT5957363LF0000X
PASP020829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily