| Organization Name: | COASTAL PHYSICIAN CARE LLC |
| NPI Number: | 1124424098 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREMY L DARSTEK (CEO) |
| Mailing Address: | 9250 Corkscrew Rd Suite 3 Estero |
| State: | FL US |
| Postal Code: | 339283208 |
| Phone Number: | 2394982528 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2014 |
| NPI Last Update Date: | 11/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |