Provider Demographics
NPI:1306095831
Name:COLEMAN, CATHERINE ELIZABETH (AA-C)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 COMMERCE CENTER DR STE H
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3135
Mailing Address - Country:US
Mailing Address - Phone:772-581-6226
Mailing Address - Fax:772-581-5771
Practice Address - Street 1:725 COMMERCE CENTER DR STE H
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3135
Practice Address - Country:US
Practice Address - Phone:772-581-6226
Practice Address - Fax:772-581-5771
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA21367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL863OtherNCCAA