Provider Demographics
NPI:1124838719
Name:COFFEE, PAIGE VICTORIA (FNP STUDENT)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:VICTORIA
Last Name:COFFEE
Suffix:
Gender:F
Credentials:FNP STUDENT
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:V
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4450 ROSITA AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-2845
Mailing Address - Country:US
Mailing Address - Phone:760-382-2739
Mailing Address - Fax:
Practice Address - Street 1:2150 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3022
Practice Address - Country:US
Practice Address - Phone:805-927-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program