Healthcare Provider Details

I. General information

NPI: 1295403848
Provider Name (Legal Business Name): ELLE R CORONEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 E CAMPBELL AVE APT 1059
PHOENIX AZ
85018-3780
US

IV. Provider business mailing address

1953 E LAGUNA DR
TEMPE AZ
85282-5912
US

V. Phone/Fax

Practice location:
  • Phone: 602-503-7231
  • Fax:
Mailing address:
  • Phone: 602-503-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number335720
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: