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General NPI Number Information
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NPI Number | 1104397793
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Entity Type | Individual
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Provider Name | BREONA COATS APRN
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Gender | Female
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Dates
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Enumeration Date | 12/08/2018
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-861-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 8230 DAMES POINT CROSSING BLVD N UNIT 904
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City | JACKSONVILLE
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State | FL
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Zip | 32277-3822
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Country | US
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Telephone | 904-861-5111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN939526
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9395326
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License Number State | FL
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