Healthcare Provider Details

I. General information

NPI: 1619871308
Provider Name (Legal Business Name): GINA LYNN COLDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

402 SW GREENVILLE BLVD STE 1A
GREENVILLE NC
27834-6965
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 252-347-0512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number315776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: