Provider Demographics
NPI:1669898896
Name:LESLIE F. COUGHLAN, NP PA
Entity type:Organization
Organization Name:LESLIE F. COUGHLAN, NP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:COUGHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP, PA
Authorized Official - Phone:561-509-6109
Mailing Address - Street 1:2623 S. SEACREST BLVD. SUITE.116
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7531
Mailing Address - Country:US
Mailing Address - Phone:561-509-6109
Mailing Address - Fax:
Practice Address - Street 1:2623 S. SEACREST BLVD.
Practice Address - Street 2:SUITE.116
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7531
Practice Address - Country:US
Practice Address - Phone:561-509-6109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty