Provider Demographics
NPI:1285181289
Name:COLEMAN, AUDREY BECKER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:BECKER
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3693
Mailing Address - Country:US
Mailing Address - Phone:629-221-1185
Mailing Address - Fax:
Practice Address - Street 1:2100 A1A S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6615
Practice Address - Country:US
Practice Address - Phone:904-605-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025828Medicaid
TN6089376OtherBCBS TN
TN6089376OtherBCBS TN