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COASTLINE MEDICAL SERVICES PLLC
NPI 1003361767
Clinic/Center - Medical Specialty in Fort Walton Beach, FL

Active since August 23, 2016CLIA 10D2141806 · Waiver
1817 LEWIS TURNER BLVD STE F, FORT WALTON BEACH, FL 32547(850) 396-1110 Get Directions Write a Review

NPPES record last updated: September 27, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 27, 2024, Oct 7, 2019, May 30, 2019 and 1 more (4 updates tracked since 2016).

About Coastline Medical Services Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COASTLINE MEDICAL SERVICES PLLC (NPI 1003361767) is a healthcare organization registered as a medical specialty in Fort Walton Beach, Florida and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through December 20, 2027 and lists Michael Tavernaris, Physician, as its authorized official.

NPPES Registry Identity

NPI1003361767
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameCOASTLINE MEDICAL SERVICES PLLC
Location Address1817 LEWIS TURNER BLVD STE FFort Walton Beach, FL 32547-1349
Mailing Address208 Mary Esther BlvdMary Esther, FL 32569-1687
Phone(850) 396-1110
Organization SubpartNo
Authorized OfficialMichael TavernarisPhysician · (850) 396-1110
Enumeration DateAugust 23, 2016
Last NPPES UpdateSeptember 27, 20244 updates tracked since enumeration
NPPES CertifiedSeptember 27, 2024
✔ NPI 1003361767 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in FL · ME116308
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
Also ListedFamily Medicine · Sports MedicineTaxonomy 207QS0010X
1817 LEWIS TURNER BLVD STE F, Fort Walton Beach, FL 32547
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2141806

Coastline Medical Services, Plcc · Fort Walton Beach, FL
Active · expires Dec 20, 2027
CLIA Number10D2141806
Laboratory TypePhysician Office
Certificate Effective DateDecember 21, 2025
Certificate Expiration DateDecember 20, 2027
Laboratory DirectorMichael E. Tavernaris
Laboratory Phone(850) 396-1110
Laboratory LocationCoastline Medical Services, Plcc1817 Lewis Turner Blvd Suite F, Fort Walton Beach, FL 32547
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHAEL E TAVERNARIS M.D.
Family Medicine
1817 LEWIS TURNER BLVD STE F
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 396-1110

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Coastline Medical Services PLLC's NPI number?

The NPI number for Coastline Medical Services PLLC is 1003361767. It was assigned to this organization in the NPPES registry on August 23, 2016.

Where is Coastline Medical Services PLLC located?

Coastline Medical Services PLLC is located at 1817 Lewis Turner Blvd Ste F, Fort Walton Beach, FL 32547. The listed phone number is (850) 396-1110.

What is Coastline Medical Services PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Does Coastline Medical Services PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2141806) is associated with this NPI, valid through December 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Coastline Medical Services PLLC was last updated on September 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.