Provider Demographics
NPI:1306673728
Name:COBBLAH, CAROLINE (NP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:COBBLAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 223RD ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1243
Mailing Address - Country:US
Mailing Address - Phone:516-604-6654
Mailing Address - Fax:
Practice Address - Street 1:13023 223RD ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1243
Practice Address - Country:US
Practice Address - Phone:516-604-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310630-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care