MEDICARE: COQUINA KEY HEALTH CARE CENTER, INC.

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	314000000X	Skilled Nursing Facility	SNF1364095	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K8D	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1134138985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COQUINA KEY HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-822-1871
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-822-1871
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STEVE STRAWN
Credential	:
Telephone Number	:	615-217-2324

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/22/2020

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