Provider Demographics
NPI:1750911574
Name:COASTAL FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:COASTAL FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MANAS
Authorized Official - Last Name:BODINE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:251-213-5824
Mailing Address - Street 1:1807 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2326
Mailing Address - Country:US
Mailing Address - Phone:251-215-4004
Mailing Address - Fax:
Practice Address - Street 1:1807 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2326
Practice Address - Country:US
Practice Address - Phone:251-213-5824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty