Healthcare Provider Details

I. General information

NPI: 1285181289
Provider Name (Legal Business Name): AUDREY BECKER COLEMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 A1A S
ST AUGUSTINE FL
32080-6615
US

IV. Provider business mailing address

1009 11TH ST N
JACKSONVILLE BEACH FL
32250-3693
US

V. Phone/Fax

Practice location:
  • Phone: 904-605-3553
  • Fax:
Mailing address:
  • Phone: 629-221-1185
  • 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: