Individual
MISS CANAAN DIANE COAKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5560 ESTABROOK WOODS DR APT 202, ORLANDO, FL 32839-6111
(321) 351-6417
Mailing address
5560 ESTABROOK WOODS DR APT 202, ORLANDO, FL 32839-6111
(321) 351-6417
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-4699754
—
FL
Enumeration date
02/01/2022
Last updated
02/01/2022
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