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General NPI Number Information
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NPI Number | 1518949676
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Entity Type | Organization
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Legal Business Name | COASTAL CARE NURSING ASSOCIATES, INC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 340 TAMIAMI TRAIL S. SUITE 203
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City | NOKOMIS
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State | FL
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Zip | 34275
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Country | US
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Telephone | 941-488-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 340 TAMIAMI TRAIL S. SUITE 203
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City | NOKOMIS
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State | FL
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Zip | 34275
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Country | US
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Telephone | 941-488-7722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. VICTORIA LYNN PETTOGRASSO
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Credential | L.P.N, B.S. MAT
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Telephone | 941-488-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 30211179
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 30211179
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License Number State | FL
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