MEDICARE: COASTAL INTERNAL MEDICINE OF JUPITER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME84437	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083957732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL INTERNAL MEDICINE OF JUPITER, PA

Provider Business Mailing Address
First Line	:	641 UNIVERSITY BLVD STE 211
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2794
Country	:	US
Telephone Number	:	561-253-8121
Fax Number	:	561-253-8021

Provider Business Practice Location Address
First Line	:	641 UNIVERSITY BLVD STE 211
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2794
Country	:	US
Telephone Number	:	561-253-8121
Fax Number	:	561-253-8021

Authorized Official
Title or Position	:	FACILITY ADMINISTRATOR
Name	:	TIFFANIE VEAU
Credential	:
Telephone Number	:	561-253-8121

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	01/16/2026

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