Individual
CHARLENE M COUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
60 WESTMINSTER ST N, SUITE A, LEHIGH ACRES, FL 33936-6518
(239) 368-1808
Mailing address
8851 BOARDROOM CIR, FORT MYERS, FL 33919-4888
(239) 481-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102270
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291756400
—
FL
Enumeration date
10/10/2005
Last updated
04/14/2014
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