Healthcare Provider Details

I. General information

NPI: 1952245631
Provider Name (Legal Business Name): COASTAL MIND & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OCEAN DR
KEY LARGO FL
33037-4315
US

IV. Provider business mailing address

PO BOX 373184
KEY LARGO FL
33037-8184
US

V. Phone/Fax

Practice location:
  • Phone: 305-301-8783
  • Fax:
Mailing address:
  • Phone: 305-301-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAYRA CASTILLO
Title or Position: RA
Credential:
Phone: 305-301-8783