Provider Demographics
NPI:1316768898
Name:PELLEGRINO, COLE (FNP-C)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:PELLEGRINO
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 1:6732 ANTILOPE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5805
Mailing Address - Country:US
Mailing Address - Phone:609-471-3951
Mailing Address - Fax:
Practice Address - Street 1:142 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3657
Practice Address - Country:US
Practice Address - Phone:760-230-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily