Provider Demographics
NPI:1508965674
Name:MCCOY, TODD D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1373
Mailing Address - Country:US
Mailing Address - Phone:844-362-2427
Mailing Address - Fax:877-293-4823
Practice Address - Street 1:2711 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1373
Practice Address - Country:US
Practice Address - Phone:844-362-2427
Practice Address - Fax:877-293-4823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA2585OtherFLORIDA LICENSE
FLPA2585OtherFLORIDA LICENSE
FLP17436Medicare UPIN