Healthcare Provider Details

I. General information

NPI: 1427512649
Provider Name (Legal Business Name): CAROLYNN ELIZABETH COY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

7799 ENGLISH HILLS RD
VACAVILLE CA
95688-9521
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-2096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number23091
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number23091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: