Provider Demographics
NPI:1780151589
Name:COASTAL PRIMARY CARE PLLC
Entity type:Organization
Organization Name:COASTAL PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIAH
Authorized Official - Last Name:RINKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:602-361-7144
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-1898
Mailing Address - Country:US
Mailing Address - Phone:602-361-7144
Mailing Address - Fax:
Practice Address - Street 1:436 CANAL DR SE
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9718
Practice Address - Country:US
Practice Address - Phone:602-361-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health