Healthcare Provider Details

I. General information

NPI: 1548194905
Provider Name (Legal Business Name): CHRISTOPHER J COLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 W HUNT HWY
SAN TAN VLY AZ
85143-4603
US

IV. Provider business mailing address

9444 E SATURN AVE
MESA AZ
85212-3268
US

V. Phone/Fax

Practice location:
  • Phone: 951-288-5817
  • Fax:
Mailing address:
  • Phone: 951-288-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number344327
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: