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General NPI Number Information
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NPI Number | 1346456555
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Entity Type | Individual
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Provider Name | JOHN FRANCIS COUGHLAN PA C
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 4550 EXECUTIVE DR SUITE 104
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City | NAPLES
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State | FL
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Zip | 34119-8805
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Country | US
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Telephone | 239-217-4434
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Fax | 239-217-4436
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Provider Business Mailing Address
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Address Line | 6910 CORKSCREW LANE
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City | NAPLES
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State | FL
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Zip | 34120
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Country | US
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Telephone | 239-595-7667
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102717
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102717
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License Number State | FL
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