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NPI Code Detail

MEDICARE: MIRIAN ANTELO COUCH PA-C

MEDICARE: MIRIAN ANTELO COUCH PA-C
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
1363AM0700XMedical Physician AssistantPA9106827FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y0FR9OTHERBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881938991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRIAN ANTELO COUCH PA-C
Provider Business Mailing Address
First Line : 6555 CHESTER AVE STE 1
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2279
Country : US
Telephone Number : 904-265-8209
Fax Number : 904-503-3577
Provider Business Practice Location Address
First Line : 6555 CHESTER AVE STE 1
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2279
Country : US
Telephone Number : 904-309-6504
Fax Number : 904-503-3577
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 02/28/2022

Similar Medicare Providers

1548886153 — MEGHAN LEIGH CHISLETT APRN
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-265-8209
Practice Fax:
1679513477 — DAVID J SAMARA MD
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-309-6504
Practice Fax: 904-503-3577
1932136314 — FIRST COAST LTC INC
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-309-6504
Practice Fax: 904-503-3577
1336214600 — ANNE M PETERSEN PA
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-265-8209
Practice Fax: 904-503-3577
1801149984 — ANDREA L HOFF PA-C
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-265-8209
Practice Fax: 904-503-3577
1336483015 — MOLLY M MULLANEY PA-C
Practice Location Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
32217-2279
Practice Phone: 904-265-8209
Practice Fax: 904-503-3577

Directions to “ MIRIAN ANTELO COUCH PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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