Provider Demographics
NPI:1134990971
Name:COLEMAN, JACOB NATHANIEL
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:NATHANIEL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MANCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6631
Mailing Address - Country:US
Mailing Address - Phone:276-701-9895
Mailing Address - Fax:
Practice Address - Street 1:423 MANCHESTER PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6631
Practice Address - Country:US
Practice Address - Phone:276-701-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001281558163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine