Provider Demographics
NPI:1649347147
Name:COATOAM, MARY ANN FRANCES (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:FRANCES
Last Name:COATOAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:FRANCES
Other - Last Name:BORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22266
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-4577
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-425-4100
Practice Address - Fax:386-258-4875
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9102357363A00000X
FLPA9102357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291742400Medicaid
FL291742400Medicaid
U0817YMedicare PIN