Provider Demographics
NPI:1497232714
Name:COLEMAN, TONI KAY
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:KAY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W MOHAVE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6349
Mailing Address - Country:US
Mailing Address - Phone:928-669-7311
Mailing Address - Fax:928-669-7415
Practice Address - Street 1:150 E. TYSON ROAD
Practice Address - Street 2:
Practice Address - City:QUARTZSITE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-8747
Practice Address - Fax:928-927-8748
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN187797163W00000X
AZTAP11394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse