Provider Demographics
NPI:1518949676
Name:COASTAL CARE NURSING ASSOCIATES, INC
Entity Type:Organization
Organization Name:COASTAL CARE NURSING ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETTOGRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BS MAT
Authorized Official - Phone:941-488-7722
Mailing Address - Street 1:340 TAMIAMI TRAIL S.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:941-488-7722
Mailing Address - Fax:
Practice Address - Street 1:340 TAMIAMI TRAIL S.
Practice Address - Street 2:SUITE 203
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275
Practice Address - Country:US
Practice Address - Phone:941-488-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211179251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health