Provider Demographics
NPI:1619293180
Name:NOTTINGHAM, COHLEEN MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:COHLEEN
Middle Name:MARIE
Last Name:NOTTINGHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3390 TAMIAMI TRL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8157
Mailing Address - Country:US
Mailing Address - Phone:941-764-0444
Mailing Address - Fax:941-764-0774
Practice Address - Street 1:3390 TAMIAMI TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8157
Practice Address - Country:US
Practice Address - Phone:941-764-0444
Practice Address - Fax:941-764-0774
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3024932363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN3024932Medicare Oscar/Certification
FLRN3024932Medicare PIN
FLRN3024932Medicare UPIN