Healthcare Provider Details

I. General information

NPI: 1215716667
Provider Name (Legal Business Name): ABIGAIL COLES BECK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 W AVENUE J STE 7
LANCASTER CA
93534-2819
US

IV. Provider business mailing address

13 EAGLE CT
EDWARDS CA
93523-2619
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-2221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95030646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: