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General NPI Number Information
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NPI Number | 1598624553
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Entity Type | Individual
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Provider Name | COLEY JACOB OLIVER FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 2828 BAYBORO ST
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City | LORIS
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State | SC
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Zip | 29569-2710
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Country | US
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Telephone | 843-716-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 3544 RAYNER COVE CT
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City | LITTLE RIVER
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State | SC
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Zip | 29566-5407
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 31233
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License Number State | SC
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