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General NPI Number Information
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NPI Number | 1841554508
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Entity Type | Organization
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Legal Business Name | COASTAL CARE TAMPA BAY
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 340 TAMIAMI TRL S STE 203
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City | NOKOMIS
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State | FL
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Zip | 34275-3179
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Country | US
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Telephone | 941-306-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 9040 TOWN CENTER PKWY 106A
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4101
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Country | US
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Telephone | 941-306-1991
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS VICTORIA PETTOGRASSO
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Credential |
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Telephone | 941-306-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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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 | 30211572
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License Number State | FL
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