Healthcare Provider Details

I. General information

NPI: 1861580581
Provider Name (Legal Business Name): REBECCA MICHELLE COFFIN APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 LAKE AVE
ASHTABULA OH
44004-3437
US

IV. Provider business mailing address

2259 LAKE AVE
ASHTABULA OH
44004-3437
US

V. Phone/Fax

Practice location:
  • Phone: 440-994-7550
  • Fax:
Mailing address:
  • Phone: 440-994-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 383422
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: