Provider Demographics
NPI:1780679399
Name:KOIRO, CAROL A (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KOIRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 35TH LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6521
Mailing Address - Country:US
Mailing Address - Phone:772-569-2330
Mailing Address - Fax:772-569-2630
Practice Address - Street 1:1155 35TH LN
Practice Address - Street 2:SUITE 100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-569-2330
Practice Address - Fax:772-569-2630
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MT000778002255A2300X
PART00159OA2255A2300X
FLPA9105520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer