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General NPI Number Information
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NPI Number | 1194031880
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Entity Type | Individual
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Provider Name | MICHAEL COULTER APRN
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Gender | Male
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 13453 N MAIN ST STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-773-4390
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Fax | 941-621-7089
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Provider Business Mailing Address
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Address Line | 13453 N MAIN ST STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-773-4390
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Fax | 941-621-7089
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9262190
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9262190
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License Number State | FL
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