Provider Demographics
NPI:1649387887
Name:MCCOY, AMY ANNELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANNELLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 JACKSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3814
Mailing Address - Country:US
Mailing Address - Phone:904-249-4645
Mailing Address - Fax:904-249-6613
Practice Address - Street 1:630 JACKSONVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3814
Practice Address - Country:US
Practice Address - Phone:904-249-4645
Practice Address - Fax:904-249-6613
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10854207Q00000X
MI5101015955207Q00000X
NC2007-01425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907945Medicaid
SCN01425Medicaid
FLP00801959OtherRR MEDICARE
FLCU374ZMedicare PIN
NC5907945Medicaid