Provider Demographics
NPI:1881200046
Name:COUGHLIN, PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:VEQUETINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 PATRIOT PKWY APT A324
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-0011
Mailing Address - Country:US
Mailing Address - Phone:508-367-8809
Mailing Address - Fax:
Practice Address - Street 1:150 ANSEL HALLET RD
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2582
Practice Address - Country:US
Practice Address - Phone:508-771-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program