Healthcare Provider Details

I. General information

NPI: 1962925628
Provider Name (Legal Business Name): LYDIA COLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W AYLESBURY RD STE 600
TIMONIUM MD
21093-4168
US

IV. Provider business mailing address

1329 N DUPONT ST APT 2
WILMINGTON DE
19806-4076
US

V. Phone/Fax

Practice location:
  • Phone: 410-575-1200
  • Fax:
Mailing address:
  • Phone: 302-233-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP031851
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberL1-0050652
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberACOO7372
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: