# COASTAL VASCULAR AND INTERVENTIONAL PLLC

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

## Provider details

- **NPI number:** 1760055289
- **Authorized official:** DANELLE FISCHER (ADMINISTRATOR)
- **Authorized official phone:** (850) 479-1805

## Contact information

- **Practice address:** 2301 N 9TH AVE STE 100, PENSACOLA, FL 32503-3986
- **Practice address phone:** (850) 479-1805
- **Practice address fax:** (850) 479-1829
- **Mailing address:** PO BOX 11982, PENSACOLA, FL 32524-1982
- **Mailing address phone:** (850) 479-1805
- **Mailing address fax:** (850) 479-1829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2021
- **Last updated:** 07/22/2021