Provider Demographics
NPI:1447234190
Name:COLE, COLLEEN J (DNP,APRN-BC, MSN, RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:J
Last Name:COLE
Suffix:
Gender:F
Credentials:DNP,APRN-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 460
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5908
Mailing Address - Country:US
Mailing Address - Phone:419-226-4300
Mailing Address - Fax:419-996-4305
Practice Address - Street 1:770 W HIGH ST STE 460
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-226-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6321207Q00000X, 363LF0000X
OHAPRNCNP022600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002964Medicaid
TNQ002964Medicaid