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General NPI Number Information
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NPI Number | 1558245035
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Entity Type | Organization
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Legal Business Name | COASTAL CARDIOLOGY AND PREVENTIVE MEDICINE INSTITUTE LLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 2575 NORTHBROOKE PLAZA DR UNIT 207
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City | NAPLES
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State | FL
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Zip | 34119-8099
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Country | US
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Telephone | 239-919-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD # 203
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-919-4342
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Fax | 239-919-4342
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MARCI CHARLAND
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Credential |
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Telephone | 231-638-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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