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General NPI Number Information
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NPI Number | 1255763314
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Entity Type | Individual
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Provider Name | MRS. NICOLE CATHERINE COUGHLIN
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Gender | Female
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 28 BREEZEWAY CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8494
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Country | US
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Telephone | 631-766-2743
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Fax |
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Provider Business Mailing Address
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Address Line | 28 BREEZEWAY CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8494
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Country | US
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Telephone | 631-766-2743
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-29175
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 3089
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA000569
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License Number State | GA
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