Provider Demographics
NPI:1710639141
Name:COFFA, ANTONIO
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:COFFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 COQUINA SHORES LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-3009
Mailing Address - Country:US
Mailing Address - Phone:416-272-2407
Mailing Address - Fax:
Practice Address - Street 1:5348 COQUINA SHORES LN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-3009
Practice Address - Country:US
Practice Address - Phone:416-272-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor