Healthcare Provider Details

I. General information

NPI: 1992725733
Provider Name (Legal Business Name): JENNIFER ANN COADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NATIONAL HEALTH CARE DR
DAYTONA BEACH FL
32114-1495
US

IV. Provider business mailing address

1203 N ATLANTIC AVE #3
NEW SMYRNA BEACH FL
32169-2203
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 386-323-7593
Mailing address:
  • Phone: 386-428-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME82931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: