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General NPI Number Information
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NPI Number | 1417732389
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Entity Type | Individual
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Provider Name | COLE MIKOS CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 14502 W MEEKER BLVD
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-5282
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Country | US
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Telephone | 623-254-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3314 N BRINDLEY AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-8547
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 263064
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License Number State | AZ
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