Healthcare Provider Details

I. General information

NPI: 1992776611
Provider Name (Legal Business Name): EDWARD NICHOLAS COHILL PHD, DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR SUITE 713
JACKSONVILLE FL
32207-8210
US

IV. Provider business mailing address

820 PRUDENTIAL DR SUITE 713
JACKSONVILLE FL
32207-8210
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5682
  • Fax: 904-346-0864
Mailing address:
  • Phone: 904-396-5682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberOS 8866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: