Provider Demographics
NPI:1942424601
Name:CORONADO, JEANNE (RPSGT)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:AMELIA
Other - Last Name:CORONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1512 SEAGULL DR
Mailing Address - Street 2:APT #308
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2447
Mailing Address - Country:US
Mailing Address - Phone:727-251-1025
Mailing Address - Fax:
Practice Address - Street 1:1512 SEAGULL DR
Practice Address - Street 2:APT #308
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685
Practice Address - Country:US
Practice Address - Phone:727-251-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic