Provider Demographics
NPI:1467058842
Name:COFFEY, ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:TOSKO RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12697 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3762
Mailing Address - Country:US
Mailing Address - Phone:440-465-7216
Mailing Address - Fax:
Practice Address - Street 1:19324 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1802
Practice Address - Country:US
Practice Address - Phone:440-356-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.435866163W00000X
OHAPRN.CNP.0027581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1467058842Medicaid