Provider Demographics
NPI:1124422985
Name:COAKLEY, TINA (ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:KATHERINE
Other - Last Name:TILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25377 ROUTE 61
Mailing Address - Street 2:
Mailing Address - City:ZWINGLE
Mailing Address - State:IA
Mailing Address - Zip Code:52079-9606
Mailing Address - Country:US
Mailing Address - Phone:563-357-3061
Mailing Address - Fax:
Practice Address - Street 1:1075 GOLDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1649
Practice Address - Country:US
Practice Address - Phone:563-900-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC118966363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics