Provider Demographics
NPI:1790109379
Name:COASTAL INSURANCE
Entity Type:Organization
Organization Name:COASTAL INSURANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MIKULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-484-7666
Mailing Address - Street 1:200 E VENICE AVE
Mailing Address - Street 2:SUITE 304B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-1941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E VENICE AVE
Practice Address - Street 2:SUITE 304B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-1941
Practice Address - Country:US
Practice Address - Phone:941-484-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD074547251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage