Provider Demographics
NPI:1972368595
Name:SZYMKIEWICZ, COLE DANIEL (AGANCP-BC)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:DANIEL
Last Name:SZYMKIEWICZ
Suffix:
Gender:M
Credentials:AGANCP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 E OVERLAND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8300
Mailing Address - Country:US
Mailing Address - Phone:208-906-9128
Mailing Address - Fax:
Practice Address - Street 1:3715 E OVERLAND RD STE 105
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8300
Practice Address - Country:US
Practice Address - Phone:208-906-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75604363LA2100X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care