MEDICARE: JAYDEN T COBURN

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	363LA2100X	Acute Care Nurse Practitioner	260854	AZ
2	163W00000X	Registered Nurse	260854	AZ

General Provider Information

NPI Number	:	1144173758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDEN T COBURN

Provider Business Mailing Address
First Line	:	2158 N GILBERT RD STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2109
Country	:	US
Telephone Number	:	480-690-5210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 N GILBERT RD STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2109
Country	:	US
Telephone Number	:	480-690-5210
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	05/04/2026

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