MEDICARE: NICOLE R COFER ARNP

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	363L00000X	Nurse Practitioner	COA.06937-NP	OH
2	363LF0000X	Family Nurse Practitioner	0024168302	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669456125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R COFER ARNP

Provider Business Mailing Address
First Line	:	1300 DIAMOND SPRINGS RD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3645
Country	:	US
Telephone Number	:	757-656-1665
Fax Number	:	757-690-0285

Provider Business Practice Location Address
First Line	:	1300 DIAMOND SPRINGS RD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3645
Country	:	US
Telephone Number	:	757-656-1665
Fax Number	:	757-690-0285

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/07/2016

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Directions to “ NICOLE R COFER ARNP” Practice Location

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