MEDICARE: ANNA BABOULAS COOMBS DNP, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209021781	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209.021781	OTHER	IL	IDFPR
2	F349320	OTHER	NY	NY NP LICENSE

General Provider Information

NPI Number	:	1104439249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA BABOULAS COOMBS DNP, FNP-BC

Provider Business Mailing Address
First Line	:	4901 SEARLE PKWY STE 150
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-5320
Country	:	US
Telephone Number	:	847-982-3363
Fax Number	:	847-733-5315

Provider Business Practice Location Address
First Line	:	1051 W RAND RD STE 101
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2315
Country	:	US
Telephone Number	:	847-221-4900
Fax Number	:	847-221-4996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	06/02/2026

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