Provider Demographics
NPI:1518960822
Name:COUGHLIN, NANCY A (RN,FNP-C)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:RN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2504
Mailing Address - Country:US
Mailing Address - Phone:315-782-9450
Mailing Address - Fax:
Practice Address - Street 1:238 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2504
Practice Address - Country:US
Practice Address - Phone:315-782-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNC337019OtherHEALTH COMMERCE SYSTEM IDENTIFIER
NYF330619OtherNEW YORK STATE REGISTRATION
MC0004731OtherDEA REGISTRATION