Provider Demographics
NPI:1366794133
Name:COYLE, CHARLOTTE MARY (DHSC, PA-C)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARY
Last Name:COYLE
Suffix:
Gender:F
Credentials:DHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DIXIE BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3845
Mailing Address - Country:US
Mailing Address - Phone:561-210-2406
Mailing Address - Fax:
Practice Address - Street 1:11 DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3845
Practice Address - Country:US
Practice Address - Phone:561-210-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2210390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program