1396630588 NPI number — MRS. DANIELLA ADELE COUGHLIN CRC

Table of content: MRS. DANIELLA ADELE COUGHLIN CRC (NPI 1396630588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396630588 NPI number — MRS. DANIELLA ADELE COUGHLIN CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
DANIELLA
Provider Middle Name:
ADELE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396630588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7929 KESSLER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31905-9562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-732-1099
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 SW 1ST ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33135-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-902-3880
Provider Business Practice Location Address Fax Number:
305-902-3885
Provider Enumeration Date:
06/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225C00000X , with the licence number:  730700 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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