Provider Demographics
NPI:1205519378
Name:COOLIDGE, KRISTIN LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:COOLIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 W WHITNEY DR STE 2E
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6564
Mailing Address - Country:US
Mailing Address - Phone:833-855-9973
Mailing Address - Fax:
Practice Address - Street 1:8088 W WHITNEY DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6564
Practice Address - Country:US
Practice Address - Phone:833-855-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily