Provider Demographics
NPI:1891123030
Name:COATES, CARLYN BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:BROOKE
Last Name:COATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14418 W MEEKER BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5283
Mailing Address - Country:US
Mailing Address - Phone:623-544-8942
Mailing Address - Fax:
Practice Address - Street 1:641 W WARNER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7266
Practice Address - Country:US
Practice Address - Phone:480-722-9828
Practice Address - Fax:480-722-9831
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant