Healthcare Provider Details

I. General information

NPI: 1275492811
Provider Name (Legal Business Name): COASTLINE VIRTUAL URGENT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 COUNTRY CLUB WAY STE 6
KINGSTON MA
02364-4116
US

IV. Provider business mailing address

34 MAPLE ST
KINGSTON MA
02364-1462
US

V. Phone/Fax

Practice location:
  • Phone: 508-591-0920
  • Fax:
Mailing address:
  • Phone: 508-591-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THUYMI TO
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 714-206-4020