Provider Demographics
NPI:1790781532
Name:COISCOU, CARMEN A (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
Last Name:COISCOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3550 BUSCHWOOD PARK DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4461
Mailing Address - Country:US
Mailing Address - Phone:813-936-5000
Mailing Address - Fax:813-936-5001
Practice Address - Street 1:3550 BUSCHWOOD PARK DR
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4461
Practice Address - Country:US
Practice Address - Phone:813-936-5000
Practice Address - Fax:813-936-5001
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME94475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2773431 00Medicaid
FL277343100Medicaid
MS0124792Medicaid
FLU7038YMedicare PIN
FL2773431 00Medicaid