# COASTAL VASCULAR AND INTERVENTIONAL PLLC

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

## Provider details

- **NPI number:** 1285888180
- **Authorized official:** DR. CHRISTOPHER J LECROY MD (OWNER, PHYSICIAN)
- **Authorized official phone:** (850) 479-1805

## Contact information

- **Practice address:** 5149 N. 9TH AVENUE, SUITE 120, PENSACOLA, FL 32504-8734
- **Practice address phone:** (850) 479-1805
- **Practice address fax:** (850) 479-1829
- **Mailing address:** P.O. BOX 11982, PENSACOLA, FL 32524-1982
- **Mailing address phone:** (850) 479-7200
- **Mailing address fax:** (850) 479-1829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/05/2008
- **Last updated:** 06/12/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000700100 | — | FL |