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General NPI Number Information
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NPI Number | 1366254625
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Entity Type | Individual
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Provider Name | ERICA CORONADO
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 21001 N TATUM BLVD STE 78-1640
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City | PHOENIX
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State | AZ
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Zip | 85050-5244
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Country | US
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Telephone | 877-222-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 14636 N 26TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85023-5018
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Country | US
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Telephone | 602-748-6870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 318121
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License Number State | AZ
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