Healthcare Provider Details

I. General information

NPI: 1346456555
Provider Name (Legal Business Name): JOHN FRANCIS COUGHLAN PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EXECUTIVE DR SUITE 104
NAPLES FL
34119-8805
US

IV. Provider business mailing address

6910 CORKSCREW LANE
NAPLES FL
34120
US

V. Phone/Fax

Practice location:
  • Phone: 239-217-4434
  • Fax: 239-217-4436
Mailing address:
  • Phone: 239-595-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102717
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: