Provider Demographics
NPI:1467559641
Name:JOAN COUPLAND, MD PA
Entity Type:Organization
Organization Name:JOAN COUPLAND, MD PA
Other - Org Name:CENTRAL FLORIDA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUPLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-706-1650
Mailing Address - Street 1:1000 W BROADWAY ST
Mailing Address - Street 2:205
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9260
Mailing Address - Country:US
Mailing Address - Phone:407-706-1650
Mailing Address - Fax:407-706-1651
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:205
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-706-1650
Practice Address - Fax:407-706-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79870261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF5015OtherMEDICARE RAILROAD GROUP
FL276167000Medicaid
FLP00370860OtherMEDICARE RAILROAD INDIVID
FL276167000Medicaid
FLDF5015OtherMEDICARE RAILROAD GROUP
FLB69067Medicare UPIN