Healthcare Provider Details

I. General information

NPI: 1508167131
Provider Name (Legal Business Name): COASTAL HOUSE CALLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 SE 10TH CT
POMPANO BEACH FL
33060-9536
US

IV. Provider business mailing address

973 SE 10TH CT
POMPANO BEACH FL
33060-9536
US

V. Phone/Fax

Practice location:
  • Phone: 954-647-5227
  • Fax: 954-380-8556
Mailing address:
  • Phone: 954-647-5227
  • Fax: 954-380-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9181925
License Number StateFL

VIII. Authorized Official

Name: MS. SHARON ATWOOD
Title or Position: PRESIDENT/NURSE PRACTITIONER
Credential: A.R.N.P.
Phone: 954-647-5227