Provider Demographics
NPI:1356415988
Name:PITKIN, CORAL (CNP)
Entity type:Individual
Prefix:MS
First Name:CORAL
Middle Name:
Last Name:PITKIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MAESTAS RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6268
Mailing Address - Country:US
Mailing Address - Phone:575-613-6118
Mailing Address - Fax:866-521-1434
Practice Address - Street 1:1331 MAESTAS RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6268
Practice Address - Country:US
Practice Address - Phone:575-613-6118
Practice Address - Fax:866-521-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR26218363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS84701Medicare UPIN