Healthcare Provider Details

I. General information

NPI: 1598690208
Provider Name (Legal Business Name): COASTAL HEALTH SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 GRAND BLVD
NEW PORT RICHEY FL
34652-4014
US

IV. Provider business mailing address

208 MAGNOLIA DR
CLEARWATER FL
33756-3834
US

V. Phone/Fax

Practice location:
  • Phone: 727-247-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HUDSON ROWAN
Title or Position: MANAGER
Credential:
Phone: 727-247-5977