Provider Demographics
NPI:1649230228
Name:GRAHAM, MARION COATES (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:COATES
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 AMERICA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2536
Mailing Address - Country:US
Mailing Address - Phone:904-923-1876
Mailing Address - Fax:866-616-0686
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP SJ COMMUNITY HEALTH CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5121
Practice Address - Fax:904-244-2270
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2233692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS73511Medicare UPIN
FLE2105YMedicare PIN