Healthcare Provider Details

I. General information

NPI: 1184556821
Provider Name (Legal Business Name): COASTAL PREMIER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARKET ST STE 111
ST AUGUSTINE FL
32095-8803
US

IV. Provider business mailing address

701 MARKET ST STE 111
ST AUGUSTINE FL
32095-8803
US

V. Phone/Fax

Practice location:
  • Phone: 904-309-2335
  • Fax:
Mailing address:
  • Phone: 904-309-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NILAY SUNIL DHARMA
Title or Position: OWNER
Credential:
Phone: 904-309-2335