Provider Demographics
NPI:1730546615
Name:COLE, CHRISTINA (FNP-BC, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COLE
Suffix:
Gender:
Credentials:FNP-BC, AGACNP-BC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:GOLIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:44 E MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-1917
Mailing Address - Country:US
Mailing Address - Phone:330-307-4546
Mailing Address - Fax:
Practice Address - Street 1:812 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3752
Practice Address - Country:US
Practice Address - Phone:217-443-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18535363LA2100X
IL209.024747363LA2100X
NY351035363LA2100X, 363LF0000X
OHCOA.18535-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0233809Medicaid