Provider Demographics
NPI:1699197046
Name:BEAUFILS, COLLEEN LADINA IRENE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LADINA IRENE
Last Name:BEAUFILS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:L
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:777 W SOUTHERN AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5015
Mailing Address - Country:US
Mailing Address - Phone:480-550-4048
Mailing Address - Fax:480-264-5099
Practice Address - Street 1:777 W SOUTHERN AVE STE 501
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5015
Practice Address - Country:US
Practice Address - Phone:480-550-4048
Practice Address - Fax:480-264-5099
Is Sole Proprietor?:No
Enumeration Date:2014-01-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9699363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily