Provider Demographics
NPI:1093308355
Name:COASTAL PRIMECARE FL GROUP
Entity Type:Organization
Organization Name:COASTAL PRIMECARE FL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKYI-AGYEKUM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-437-1529
Mailing Address - Street 1:8291 DANI DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8021
Mailing Address - Country:US
Mailing Address - Phone:239-931-6049
Mailing Address - Fax:
Practice Address - Street 1:8291 DANI DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-8021
Practice Address - Country:US
Practice Address - Phone:239-931-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316422199OtherNPI