Provider Demographics
NPI:1992560437
Name:SOSA, COELITHIA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:COELITHIA
Middle Name:NICOLE
Last Name:SOSA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17754 E SUNDEW ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8828
Mailing Address - Country:US
Mailing Address - Phone:954-625-5761
Mailing Address - Fax:
Practice Address - Street 1:17754 E SUNDEW ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8828
Practice Address - Country:US
Practice Address - Phone:954-625-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant