Provider Demographics
NPI:1508512427
Name:COULTER, CORAZON J (MSN APN -C)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:J
Last Name:COULTER
Suffix:
Gender:F
Credentials:MSN APN -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JENNY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1532
Mailing Address - Country:US
Mailing Address - Phone:609-464-3852
Mailing Address - Fax:
Practice Address - Street 1:6410 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-1216
Practice Address - Country:US
Practice Address - Phone:609-523-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG09210054363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care