Connie S. Cole, NP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

71003622A Issued in IN

Practice address

5900 E 500 N
Kendallville, IN 46755-9349

Phone

(260) 349-8185

NPI assigned

May 27, 2011

Last updated

May 27, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Connie S. Carunchia Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Connie S Carunchia Professional Corporation

  • Gerontology Nurse Practitioner
  • Kendallville, IN
  • NPI 1487948816
  Authorized official Same address or phone
• Purdue University

  dba IPFW Center for Health Living: Campus Clinic and Wellnes Program

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1679917710
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401148800000",
    "number": "1255624912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 E 500 N",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467559349",
            "telephone_number": "260-347-5630",
            "fax_number": "888-347-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 E 500 N",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467559349",
            "telephone_number": "260-349-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "CONNIE",
        "middle_name": "S.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-27",
        "last_updated": "2014-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71003622A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71003622A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01055058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201023770",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "CARUNCHIA",
            "middle_name": "S.",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffery Lee Ciocca, PT
• City of Kendallville Fire Department
• Cynthia Lynn Clark, MSW, LCSW, ACSW
• Mariah Clark, RBT
• Vincent J Coda, DPM
• Community Hospital of Noble County, Inc. (Parkview Noble Hospital)
• Community Hospital of Noble County, Inc. (Parkview Noble Hospital)
• Kassidy Conley, RBT
• Connie S Carunchia Professional Corporation
• Patrick John Connolly, PHD

• Gerontology Nurse Practitioner in Kendallville, IN
• Providers in Kendallville, IN by specialty
• Gerontology Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.