Healthcare Provider Details

I. General information

NPI: 1649817263
Provider Name (Legal Business Name): COASTAL HEARING CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 09/02/2025
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 RANCH LAKE BLVD STE 110
LAKEWOOD RANCH FL
34202-3719
US

IV. Provider business mailing address

5860 RANCH LAKE BLVD STE 110
LAKEWOOD RANCH FL
34202-3719
US

V. Phone/Fax

Practice location:
  • Phone: 941-229-2122
  • Fax: 941-757-3732
Mailing address:
  • Phone: 941-229-2122
  • Fax: 941-757-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KRISTIN C DESERMIA
Title or Position: OWNER
Credential: AU.D.
Phone: 941-229-2122