Basic Information
| Provider Information | |||||||||
| NPI: | 1023564135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFEY | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 E SPEEDWAY BLVD # 300 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857163917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208335171 | ||||||||
| FaxNumber: | 5208727929 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 N ALVERNON WAY STE 251 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857111879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203238460 | ||||||||
| FaxNumber: | 5203225742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP8945 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 181731 | 05 | AZ | MEDICAID |