Provider Demographics
NPI:1467793000
Name:COLEMAN, DAKSHABEN PATEL (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DAKSHABEN
Middle Name:PATEL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:DAKSHA
Other - Middle Name:PATEL
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:3617 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1090
Mailing Address - Country:US
Mailing Address - Phone:229-244-3689
Mailing Address - Fax:
Practice Address - Street 1:3617 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1090
Practice Address - Country:US
Practice Address - Phone:229-244-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144943363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health