Provider Demographics
NPI:1962626085
Name:KOE, ANTOINETTE NAVARRO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:NAVARRO
Last Name:KOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE
Mailing Address - Street 2:BLDG.12
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-269-9777
Mailing Address - Fax:904-264-9774
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:BLDG.12
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-269-9777
Practice Address - Fax:904-264-9774
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067262900Medicaid
FLD52720Medicare UPIN
FL067262900Medicaid