Provider Demographics
NPI:1295199172
Name:COASTAL FOOT & ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:COASTAL FOOT & ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-995-8572
Mailing Address - Street 1:7035 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1203
Mailing Address - Country:US
Mailing Address - Phone:727-347-8872
Mailing Address - Fax:727-343-6670
Practice Address - Street 1:7035 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1203
Practice Address - Country:US
Practice Address - Phone:727-347-8872
Practice Address - Fax:727-343-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7564060001Medicare NSC