Healthcare Provider Details

I. General information

NPI: 1033141510
Provider Name (Legal Business Name): JOHN P. COUGHLIN M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 BRUCE B DOWNS BLVD
TAMPA FL
33612-9201
US

IV. Provider business mailing address

12220 BRUCE B DOWNS BLVD
TAMPA FL
33612-9201
US

V. Phone/Fax

Practice location:
  • Phone: 813-631-5034
  • Fax: 813-631-5061
Mailing address:
  • Phone: 813-631-5034
  • Fax: 813-631-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME67720
License Number StateFL

VIII. Authorized Official

Name: JOHN PATRICK COUGHLIN
Title or Position: PEDIATRIC SURGEON
Credential: M.D. P.A.
Phone: 813-631-5034