Healthcare Provider Details

I. General information

NPI: 1902448236
Provider Name (Legal Business Name): TONYA COATES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 WEST MAIN ST
SANTAQUIN UT
84655
US

IV. Provider business mailing address

94 WEST MAIN ST
SANTAQUIN UT
84655
US

V. Phone/Fax

Practice location:
  • Phone: 801-754-3122
  • Fax:
Mailing address:
  • Phone: 801-754-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number6561651-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6561651-8900
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6561651-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: