Provider Demographics
NPI:1679701064
Name:COASTAL MEDICAL & WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:COASTAL MEDICAL & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-5277
Mailing Address - Street 1:3257 SE SALERNO RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6736
Mailing Address - Country:US
Mailing Address - Phone:772-286-5277
Mailing Address - Fax:772-286-9478
Practice Address - Street 1:3257 SE SALERNO RD
Practice Address - Street 2:SUITE 3
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6736
Practice Address - Country:US
Practice Address - Phone:772-286-5277
Practice Address - Fax:772-286-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8186111N00000X
FLME1041532084N0400X
FLARNP9174934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM458AMedicare PIN