MEDICARE: COASTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1770312845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTH

Provider Business Mailing Address
First Line	:	315 N RIDGEWOOD AVE
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-1617
Country	:	US
Telephone Number	:	386-427-8403
Fax Number	:

Provider Business Practice Location Address
First Line	:	9428 BAYMEADOWS RD STE 250
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7970
Country	:	US
Telephone Number	:	386-427-8403
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	TIMOTHY STEFLIK
Credential	:	DC
Telephone Number	:	386-427-8403

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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Directions to “COASTAL HEALTH ” Practice Location

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