Prohealth Primary Care LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9102717 Issued in FL

Legal business name

PROHEALTH PRIMARY CARE LLC

Practice address

1656 Medical Blvd
#302
Naples, FL 34110

Phone

(239) 514-4799

Fax

(239) 514-3621

NPI assigned

Apr 15, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Francis Coughlan, PA C

Title

Owner

Phone

(239) 949-5585

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1730405796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1656 EXECUTIVE DR",
            "address_2": "#302",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "34110",
            "telephone_number": "239-514-4799",
            "fax_number": "239-514-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1656 MEDICAL BLVD",
            "address_2": "#302",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "34110",
            "telephone_number": "239-514-4799",
            "fax_number": "239-514-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "COUGHLAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-949-5585",
        "authorized_official_credential": "PA C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Naples, FL
• Providers in Naples, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.