Healthcare Provider Details

I. General information

NPI: 1134042948
Provider Name (Legal Business Name): COASTAL TRANSITIONAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 QUINLAN RD E
JACKSONVILLE FL
32225-2630
US

IV. Provider business mailing address

1425 QUINLAN RD E
JACKSONVILLE FL
32225-2630
US

V. Phone/Fax

Practice location:
  • Phone: 904-962-8714
  • Fax:
Mailing address:
  • Phone: 904-962-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JESSE MCDONALD
Title or Position: PA-C
Credential: PA-C
Phone: 904-962-8714