Individual
JESSICA COOLIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-4396
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-4396
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
901454
MS
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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