Provider Demographics
NPI:1962924563
Name:CORONADO, ANA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:ISABEL
Last Name:CORONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:17180 ROYAL PALM BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2394
Practice Address - Country:US
Practice Address - Phone:954-276-1474
Practice Address - Fax:954-385-6026
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1547132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118241700Medicaid