Provider Demographics
NPI:1639814577
Name:COE, RAVEN ALEXYS (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:ALEXYS
Last Name:COE
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SW LINCOLN CIR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1311
Mailing Address - Country:US
Mailing Address - Phone:954-599-5379
Mailing Address - Fax:
Practice Address - Street 1:4018 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5202
Practice Address - Country:US
Practice Address - Phone:813-651-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9115879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant