MEDICARE: COASTAL CARE NURSING ASSOCIATES, 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	251E00000X	Home Health Agency	30211179	FL
2	251J00000X	Nursing Care Agency	30211179	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	:	1518949676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CARE NURSING ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	340 TAMIAMI TRAIL S.
Second Line	:	SUITE 203
City	:	NOKOMIS
State	:	FL
Zip	:	34275
Country	:	US
Telephone Number	:	941-488-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 TAMIAMI TRAIL S.
Second Line	:	SUITE 203
City	:	NOKOMIS
State	:	FL
Zip	:	34275
Country	:	US
Telephone Number	:	941-488-7722
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. VICTORIA LYNN PETTOGRASSO
Credential	:	L.P.N, B.S. MAT
Telephone Number	:	941-488-7722

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	06/15/2016

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