Healthcare Provider Details

I. General information

NPI: 1619325115
Provider Name (Legal Business Name): JOHN ANTHONY COPPOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD SUITE HD-408
GAINESVILLE FL
32610-0296
US

IV. Provider business mailing address

PO BOX 100296 1600 SW ARCHER ROAD SUITE HD-408
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME140324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: