COASTLINE MEDICAL SERVICES PLLC (NPI# 1003361767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003361767 |
| Entity Type | Organization |
| Organization Name | COASTLINE MEDICAL SERVICES PLLC |
| Practice Address |
208 Mary Esther Blvd Mary Esther FL 32569-1687 |
| Practice Telephone | 9082658949 |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2019-10-07 |
| Authorized Official Name | DR. MICHAEL TAVERNARIS (PHYSICIAN) |
| Authorized Official Telephone | 8503961110 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
ME116308 | FL | Ambulatory Health Care Facilities |
| Street Address |
208 MARY ESTHER BLVD |
| City | MARY ESTHER |
| State | FL |
| Zip Code | 32569-1687 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386888626 | Michael E Tavernaris | Family Medicine | 208 Mary Esther Blvd, Mary Esther, FL 32569-1687 | 2009-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174132252 | Myra Jean Luna | Behavior Technician | 140 Cristobal Road N, Suite 501, Mary Esther, FL 32569 | 2020-07-24 |
| 1780242982 | Florida Kids Ppec, LLC | Skilled Nursing Facility | 5 E. Lane Dr., Units A/b, Mary Esther, FL 32569 | 2019-06-03 |
| 1730604695 | Camille Martinez | Behavior Technician | 116 Fourth St Se Unit #c, Fort Walton Beach, FL 32569 | 2017-08-11 |
| 1265846000 | Stillwaters Counseling, LLC | Counselor | 425 East Hollywood Boulevard, Building C, Suite #c5, Mary Esther, FL 32569 | 2014-06-19 |
| 1649562729 | Elizabeth Ann Hutchinson | Nurse Practitioner | 151 Mary Esther Blvd # 301, Mary Esther, FL 32569 | 2011-05-09 |
| 1215237789 | Nekita Antionette Robinson | Licensed Practical Nurse | 24 Solar Street, Mary Esther, FL 32569 | 2010-10-29 |
| 1538395587 | Angela Marie Meadows | Nurse Practitioner | 151 Mary Esther Blvd Ste 403a, Mary Esther, FL 32569 | 2009-06-04 |
| 1891939831 | Tamara Fought Bertrand | Massage Therapist | 151 Mary Ester Blvd, Suite 309b, Apo, AP 32569 | 2009-04-21 |
| 1083705651 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 300 Mary Esther Cutoff, Mary Esther, FL 32569 | 2006-09-27 |
| 1467823922 | Ashley Rydzewski Hall | Pharmacist | 250 E Miracle Strip Pkwy, Mary Esther, FL 32569 | 2015-10-09 |
| Find all providers in zip 32569 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1487214342 | Patrick Robinson Md LLC | Clinic/Center | 12630 Curley St Ste 104, San Antonio, FL 33576-8095 | 2019-06-13 |
| Find all providers with the same taxonomy | ||||
| City | MARY ESTHER |
| Zip Code | 32569 |
Please comment or provide details below to improve the information on COASTLINE MEDICAL SERVICES PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.