Provider Demographics
NPI:1285396598
Name:COLE, CARY ROBERT (FNP-C)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:ROBERT
Last Name:COLE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 W HAPPY VALLEY PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2878
Mailing Address - Country:US
Mailing Address - Phone:480-737-5076
Mailing Address - Fax:
Practice Address - Street 1:10200 W HAPPY VALLEY PKWY STE 125
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2878
Practice Address - Country:US
Practice Address - Phone:480-737-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ314005363LF0000X
AZRN213081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty