MEDICARE: ABIGAIL COQUILLA INSURANCE PRODUCER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	3497	MS
2	225700000X	Massage Therapist	11379	NV
3	225700000X	Massage Therapist	95305	FL

General Provider Information

NPI Number	:	1386427821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL COQUILLA INSURANCE PRODUCER

Provider Business Mailing Address
First Line	:	313 CENTRAL AVE STE B
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-3915
Country	:	US
Telephone Number	:	601-551-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 CENTRAL AVE STE B
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-3915
Country	:	US
Telephone Number	:	601-551-7064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	03/30/2026

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Directions to “ ABIGAIL COQUILLA INSURANCE PRODUCER” Practice Location

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