Healthcare Provider Details

I. General information

NPI: 1356924740
Provider Name (Legal Business Name): COASTAL PREMIER MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 TAMIAMI TRL N
NAPLES FL
34110-6217
US

IV. Provider business mailing address

340 TAMIAMI TRL N PMB 162
NAPLES FL
34102-5803
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-0723
  • Fax:
Mailing address:
  • Phone: 239-316-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA L JONES
Title or Position: FAMILY NURSE PRACTITIONER
Credential: ARNP
Phone: 614-738-2161