Provider Demographics
NPI:1992723852
Name:COOLMAN, ELIZABETH ANN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:COOLMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 INCA RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7558
Mailing Address - Country:US
Mailing Address - Phone:321-289-8614
Mailing Address - Fax:
Practice Address - Street 1:914 PINEHURST RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-896-9412
Practice Address - Fax:505-896-9461
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2012-0055363AM0700X
FLPA9103491363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292956200Medicaid
FLP00789777OtherRAILROAD MEDICARE PTAN
FLP00789777OtherRAILROAD MEDICARE PTAN
FLU8411ZMedicare PIN