MEDICARE: LESLIE F. COUGHLAN, NP PA

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1669898896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE F. COUGHLAN, NP PA

Provider Business Mailing Address
First Line	:	2623 S. SEACREST BLVD. SUITE.116
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7531
Country	:	US
Telephone Number	:	561-509-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 S. SEACREST BLVD.
Second Line	:	SUITE.116
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7531
Country	:	US
Telephone Number	:	561-509-6109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE F COUGHLAN
Credential	:	NP, PA
Telephone Number	:	561-509-6109

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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