Provider Demographics
NPI:1679463343
Name:COFFMAN, XIOMARA ELISA
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:ELISA
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13196 SW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5016
Mailing Address - Country:US
Mailing Address - Phone:352-454-7599
Mailing Address - Fax:
Practice Address - Street 1:13196 SW 106TH ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-5016
Practice Address - Country:US
Practice Address - Phone:352-454-7599
Practice Address - Fax:352-454-7599
Is Sole Proprietor?:No
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9565105163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health