Provider Demographics
NPI:1790221745
Name:COFIELD, CARLOTTA (BSN)
Entity Type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:
Last Name:COFIELD
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W BEAVER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1414
Mailing Address - Country:US
Mailing Address - Phone:904-712-3540
Mailing Address - Fax:904-775-3570
Practice Address - Street 1:1225 W BEAVER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1414
Practice Address - Country:US
Practice Address - Phone:904-712-3540
Practice Address - Fax:904-775-3570
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLRN9421693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101Y00000XBehavioral Health & Social Service ProvidersCounselor