Healthcare Provider Details

I. General information

NPI: 1235103029
Provider Name (Legal Business Name): COASTAL HEALTH SYSTEMS OF BREVARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 GUS HIPP BLVD
ROCKLEDGE FL
32955-4800
US

IV. Provider business mailing address

486 GUS HIPP BLVD
ROCKLEDGE FL
32955-4800
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-7050
  • Fax: 321-632-3005
Mailing address:
  • Phone: 321-633-7050
  • Fax: 321-632-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number002591
License Number StateFL

VIII. Authorized Official

Name: MS. ANDREA BROOKE TAYLOR
Title or Position: CEO
Credential:
Phone: 321-633-7050