MEDICARE: ELLE R CORONEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	335720	AZ
2	163W00000X	Registered Nurse	RN212513	AZ

General Provider Information

NPI Number	:	1295403848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLE R CORONEL

Provider Business Mailing Address
First Line	:	1953 E LAGUNA DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5912
Country	:	US
Telephone Number	:	602-503-7231
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 E CAMPBELL AVE APT 1059
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3780
Country	:	US
Telephone Number	:	602-503-7231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	03/13/2026

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