MEDICARE: COASTAL PEAKS PSYCHIATRY PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1588524151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL PEAKS PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	871 VENETIA BAY BLVD STE 201
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-8049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 VENETIA BAY BLVD STE 201
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-8049
Country	:	US
Telephone Number	:	941-202-6126
Fax Number	:	941-200-4424

Authorized Official
Title or Position	:	OWNER
Name	:	MR. J. RICHARD BESHORE
Credential	:	PMHNP
Telephone Number	:	941-202-6126

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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