Individual
ELIZABETH ANN COOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
914 PINEHURST RD NE, RIO RANCHO, NM 87124
(505) 896-9412
(505) 896-9461
Mailing address
2605 INCA RD NE, RIO RANCHO, NM 87144-7558
(321) 289-8614
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2012-0055
NM
363AM0700X
Medical Physician Assistant
PA9103491
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292956200
—
FL
01
—
P00789777
RAILROAD MEDICARE PTAN
FL
Enumeration date
07/18/2006
Last updated
07/01/2013
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