Provider Demographics
NPI:1093937963
Name:EMERALD COAST FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:EMERALD COAST FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-729-3300
Mailing Address - Street 1:143 S JOHN SIMS PKWY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1271
Mailing Address - Country:US
Mailing Address - Phone:850-729-3300
Mailing Address - Fax:850-729-3100
Practice Address - Street 1:143 S JOHN SIMS PKWY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1271
Practice Address - Country:US
Practice Address - Phone:850-729-3300
Practice Address - Fax:850-729-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBC6530376OtherDEA#
FLBC6530376OtherDEA#