Provider Demographics
NPI:1346594009
Name:COOMBS, QUANNE SIMONE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:QUANNE
Middle Name:SIMONE
Last Name:COOMBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:QUANNE
Other - Middle Name:
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1303 HOMESTEAD RD N
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6049
Mailing Address - Country:US
Mailing Address - Phone:239-303-2700
Mailing Address - Fax:239-303-2756
Practice Address - Street 1:1303 HOMESTEAD RD N
Practice Address - Street 2:SUITE #102
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6049
Practice Address - Country:US
Practice Address - Phone:239-303-2700
Practice Address - Fax:239-303-2756
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant