Provider Demographics
NPI:1922856525
Name:COASTAL MOBILE MEDICAL CARE LLC
Entity type:Organization
Organization Name:COASTAL MOBILE MEDICAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-643-6346
Mailing Address - Street 1:8825 PERIMETER PARK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1126
Mailing Address - Country:US
Mailing Address - Phone:904-643-6346
Mailing Address - Fax:904-441-7554
Practice Address - Street 1:8825 PERIMETER PARK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1126
Practice Address - Country:US
Practice Address - Phone:904-643-6346
Practice Address - Fax:904-441-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9108134OtherPA