Provider Demographics
NPI:1437208402
Name:WEST COAST FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WEST COAST FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-961-9393
Mailing Address - Street 1:11018 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3802
Mailing Address - Country:US
Mailing Address - Phone:813-961-9393
Mailing Address - Fax:813-960-9020
Practice Address - Street 1:11018 N DALE MABRY HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3802
Practice Address - Country:US
Practice Address - Phone:813-961-9393
Practice Address - Fax:813-960-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1320912363LF0000X
FL416522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1740248384OtherNPI NUMBER
FLY6961Medicare ID - Type Unspecified
FL1740248384OtherNPI NUMBER
FLE3955Medicare ID - Type Unspecified
FL1083691075Medicare ID - Type UnspecifiedNPI
FLP04449Medicare UPIN
FLS71231Medicare UPIN