Provider Demographics
NPI:1336861814
Name:COLES, AMANDA ALICE CAGGIANO (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALICE CAGGIANO
Last Name:COLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ALICE
Other - Last Name:CAGGIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3 HIGH MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2625
Mailing Address - Country:US
Mailing Address - Phone:845-590-3801
Mailing Address - Fax:
Practice Address - Street 1:830 SILVER ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2990
Practice Address - Country:US
Practice Address - Phone:413-363-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281792363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health