Provider Demographics
NPI:1134560634
Name:COLE, PAMELLA E (APN)
Entity type:Individual
Prefix:MRS
First Name:PAMELLA
Middle Name:E
Last Name:COLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:PAMELLA
Other - Middle Name:E
Other - Last Name:BRACKENRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1214
Mailing Address - Country:US
Mailing Address - Phone:732-977-6746
Mailing Address - Fax:
Practice Address - Street 1:57 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1214
Practice Address - Country:US
Practice Address - Phone:732-977-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00448800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health