Healthcare Provider Details

I. General information

NPI: 1508512427
Provider Name (Legal Business Name): CORAZON J COULTER MSN APN -C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 VENTNOR AVE
VENTNOR CITY NJ
08406-2166
US

IV. Provider business mailing address

6725 VENTNOR AVE
VENTNOR CITY NJ
08406-2166
US

V. Phone/Fax

Practice location:
  • Phone: 609-350-6780
  • Fax:
Mailing address:
  • Phone: 609-350-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG09210054
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: