MIRIAN ANTELO COUCH PA-C NPI 1881938991

NPI Information

NPI: 1881938991
Provider Name: MIRIAN ANTELO COUCH, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
6555 CHESTER AVE STE 1
JACKSONVILLE, FL
ZIP 32217
Phone: (904) 309-6504
Get Directions

Mirian Antelo Couch, PA-C is a medical physician assistant in Jacksonville, FL. Mirian Antelo Couch, PA-C NPI is 1881938991. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6555 CHESTER AVE STE 1
JACKSONVILLE, FL
ZIP 32217-279
Phone: (904) 309-6504
Fax: (904) 503-3577

The NPI 1881938991 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/15/2012 and was last updated on 2/28/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA9106827	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100513100	MEDICAID	FLORIDA
2	Y0FR9	OTHER		BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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