Provider Demographics
NPI:1720461320
Name:COONCE, ALICIA J (DO)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:J
Last Name:COONCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5722
Mailing Address - Country:US
Mailing Address - Phone:407-841-7290
Mailing Address - Fax:407-636-7800
Practice Address - Street 1:414 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-841-7290
Practice Address - Fax:407-636-7800
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15436208000000X
FLOF15436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100147500Medicaid