| Coastal Senior Healthcare Inc | |
|
3914 E State Road 64 Bradenton FL 34208-9059 | |
| (941) 216-3800 | |
| (941) 216-3703 |
| Full Name | Coastal Senior Healthcare Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3914 E State Road 64, Bradenton, Florida |
| Authorized Official Name and Position | John K Mcdermott (PRESIDENT) |
| Authorized Official Contact | 9412163800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Senior Healthcare Inc 3914 E State Road 64 Bradenton FL 34208-9059 Ph: (941) 216-3800 | Coastal Senior Healthcare Inc 3914 E State Road 64 Bradenton FL 34208-9059 Ph: (941) 216-3800 |
| NPI Number | 1497289110 |
|---|---|
| Provider Enumeration Date | 04/19/2017 |
| Last Update Date | 03/22/2023 |
| Medicare PECOS PAC ID | 3678840600 |
|---|---|
| Medicare Enrollment ID | O20170523002359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497289110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel J Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740206549 PECOS PAC ID: 4183701386 Enrollment ID: I20080412000110 |
| Provider Name | Regina Lydon Soderberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508151838 PECOS PAC ID: 1557539509 Enrollment ID: I20110719000641 |
| Provider Name | Diane L Raccio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053578377 PECOS PAC ID: 5092888388 Enrollment ID: I20121227000380 |
| Provider Name | Catherine I Mcdermott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609838119 PECOS PAC ID: 4385620517 Enrollment ID: I20131105001473 |
| Provider Name | Autumn Nicole Stevanus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689139297 PECOS PAC ID: 6002156940 Enrollment ID: I20190313000119 |
| Provider Name | Brianne Ronelle Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891307500 PECOS PAC ID: 9234545815 Enrollment ID: I20210305000370 |
| Provider Name | Beth Robin Domino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295204741 PECOS PAC ID: 9931592920 Enrollment ID: I20220216000634 |
| Provider Name | Julie Christine Clement |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083175665 PECOS PAC ID: 9638537996 Enrollment ID: I20230617000429 |
| Provider Name | Erin Mary Albright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205611712 PECOS PAC ID: 9234572256 Enrollment ID: I20240207000868 |
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