Healthcare Provider Details

I. General information

NPI: 1336085745
Provider Name (Legal Business Name): COASTAL NEURO CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 SHORELINE CIR
PONTE VEDRA BEACH FL
32082-2741
US

IV. Provider business mailing address

868 SHORELINE CIR
PONTE VEDRA BEACH FL
32082-2741
US

V. Phone/Fax

Practice location:
  • Phone: 904-866-9551
  • Fax:
Mailing address:
  • Phone: 904-866-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY GROBSTICK
Title or Position: PRESIDENT
Credential: APRN
Phone: 904-866-9551