COASTLINE PRIMARY CARE
NPI 1114572245
Family Medicine - Adult Medicine in Edgewater, FL

Q: What is Coastal Esthetics, LLC's NPI number?

The NPI number for Coastal Esthetics, LLC is 1114572245. It was assigned to this organization in the NPPES registry on August 6, 2019. The provider is doing business as Coastline Primary Care.

Q: What is Coastal Esthetics, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Active since August 06, 2019

109 W KNAPP AVE, EDGEWATER, FL 32132(386) 957-4100(386) 957-4104 Get Directions Write a Review

NPPES record last updated: April 26, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 26, 2022, Aug 6, 2019 (2 updates tracked since 2019).

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About Coastline Primary Care NPPES

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

COASTLINE PRIMARY CARE (NPI 1114572245) is a healthcare organization registered as an adult medicine in Edgewater, Florida and active in the NPI registry since August 2019. The organization lists Carissa Peterson, Owner/aprn, as its authorized official.

NPPES Registry Identity

NPI1114572245

Entity TypeOrganization

Primary Taxonomy207QA0505X

Legal Business NameCOASTAL ESTHETICS, LLC

Location Address109 W KNAPP AVEEdgewater, FL 32132-1555

Mailing Address109 W Knapp AveEdgewater, FL 32132-1555 · (386) 957-4100 · Fax (386) 957-4104

Phone(386) 957-4100

Fax(386) 957-4104

Organization SubpartNo

Authorized OfficialCarissa PetersonOwner/aprn · (386) 957-4100

Enumeration DateAugust 6, 2019

Last NPPES UpdateApril 26, 20222 updates tracked since enumeration

NPPES CertifiedApril 26, 2022

✔ NPI 1114572245 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0505X

Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

109 W KNAPP AVE, Edgewater, FL 32132

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Other Names 1

Doing Business AsCoastline Primary Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

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

STEPHANIE L STRATTON-BOONE R.D.

Dietitian, Registered