Provider Demographics
NPI:1477320612
Name:COATS, MARIA DE LOURDES DE LOURDES (APRN)
Entity Type:Individual
Prefix:
First Name:MARIA DE LOURDES
Middle Name:DE LOURDES
Last Name:COATS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 TPC BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2850
Mailing Address - Country:US
Mailing Address - Phone:424-903-5647
Mailing Address - Fax:
Practice Address - Street 1:5608 TPC BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-2850
Practice Address - Country:US
Practice Address - Phone:424-903-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111028947363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology