Healthcare Provider Details

I. General information

NPI: 1174241277
Provider Name (Legal Business Name): MELISA SUZANNE COFFIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SAM RITTENBERG BLVD STE 201
CHARLESTON SC
29407-4137
US

IV. Provider business mailing address

1565 SAM RITTENBERG BLVD STE 201
CHARLESTON SC
29407-4137
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-1353
  • Fax: 843-818-4172
Mailing address:
  • Phone: 843-793-1353
  • Fax: 843-818-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25568
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: