Provider Demographics
NPI:1669456125
Name:COFER, NICOLE R (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:COFER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DIAMOND SPRINGS RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3645
Mailing Address - Country:US
Mailing Address - Phone:757-656-1665
Mailing Address - Fax:757-690-0285
Practice Address - Street 1:1300 DIAMOND SPRINGS RD
Practice Address - Street 2:SUITE 503
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3645
Practice Address - Country:US
Practice Address - Phone:757-656-1665
Practice Address - Fax:757-690-0285
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.06937-NP363L00000X
VA0024168302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2265883Medicaid
VA1669456125Medicaid
VAHANP17771Medicare PIN
OHG38787Medicare UPIN