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General NPI Number Information
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NPI Number | 1760367452
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Entity Type | Organization
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Legal Business Name | COASTAL CARE AND WELLNESS PLLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 2100 SE HILLMOOR DR STE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-8057
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Country | US
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Telephone | 561-262-8785
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Fax |
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Provider Business Mailing Address
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Address Line | 612 SE FLAMINGO AVE
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City | STUART
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State | FL
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Zip | 34996-3249
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Country | US
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Telephone | 561-262-8785
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER M QADIR
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Credential | PA-C
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Telephone | 561-688-9565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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