# COASTLINE MEDICAL SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003361767
- **Authorized official:** DR. MICHAEL TAVERNARIS M.D (PHYSICIAN)
- **Authorized official phone:** (850) 396-1110

## Contact information

- **Practice address:** 1817 LEWIS TURNER BLVD STE F, FORT WALTON BEACH, FL 32547-1349
- **Practice address phone:** (850) 396-1110
- **Mailing address:** 208 MARY ESTHER BLVD, MARY ESTHER, FL 32569-1687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | ME116308 | FL | Yes |

## Other

- **Enumeration date:** 08/23/2016
- **Last updated:** 09/27/2024