MEDICARE: COASTAL FOOT & ANKLE SPECIALISTS LLC

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	213E00000X	Podiatrist

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	:	1295199172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL FOOT & ANKLE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	7035 1ST AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-1203
Country	:	US
Telephone Number	:	727-347-8872
Fax Number	:	727-343-6670

Provider Business Practice Location Address
First Line	:	7035 1ST AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-1203
Country	:	US
Telephone Number	:	727-347-8872
Fax Number	:	727-343-6670

Authorized Official
Title or Position	:	OWNER
Name	:	HEATHER ZELNA
Credential	:	DPM
Telephone Number	:	732-995-8572

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	12/21/2020

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