Healthcare Provider Details

I. General information

NPI: 1558245035
Provider Name (Legal Business Name): COASTAL CARDIOLOGY AND PREVENTIVE MEDICINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 NORTHBROOKE PLAZA DR UNIT 207
NAPLES FL
34119-8099
US

IV. Provider business mailing address

2338 IMMOKALEE RD # 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-919-4342
  • Fax:
Mailing address:
  • Phone: 239-919-4342
  • Fax: 239-919-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCI CHARLAND
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 231-638-1853