Healthcare Provider Details

I. General information

NPI: 1982051967
Provider Name (Legal Business Name): ELIZABETH COGGINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PRINCETON AVE SW SUITE 199
BIRMINGHAM AL
35211-1333
US

IV. Provider business mailing address

817 PRINCETON AVE SW SUITE 199
BIRMINGHAM AL
35211-1333
US

V. Phone/Fax

Practice location:
  • Phone: 205-780-1920
  • Fax: 205-780-1967
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1125000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: