Healthcare Provider Details

I. General information

NPI: 1578408373
Provider Name (Legal Business Name): MADISON BROOKE COOMBS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD FL 1
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

1907 DOOMAR DR
TALLAHASSEE FL
32308-4805
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5000
  • Fax:
Mailing address:
  • Phone: 850-567-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: