Provider Demographics
NPI:1407841729
Name:COASTAL NURSECARE OF FLORIDA, INC.
Entity type:Organization
Organization Name:COASTAL NURSECARE OF FLORIDA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP CGRO
Authorized Official - Prefix:
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-3443
Mailing Address - Street 1:801 WARRENVILLE RD STE 800
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0912
Mailing Address - Country:US
Mailing Address - Phone:850-475-9000
Mailing Address - Fax:850-475-9330
Practice Address - Street 1:2160 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7218
Practice Address - Country:US
Practice Address - Phone:850-475-9000
Practice Address - Fax:850-475-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991520251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650996700Medicaid
FL685500800Medicaid
FL684119896Medicaid
FLJP4OtherBLUE CROSS BLUE SHIELD