Organization
COASTAL ESTHETICS, LLC
Active
Other names
Coastline Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
CARISSA PETERSON APRN (OWNER/APRN)
(386) 957-4100
Entity
Organization
Contact information
Practice address
109 W KNAPP AVE, EDGEWATER, FL 32132-1555
(386) 957-4100
(386) 957-4104
Mailing address
109 W KNAPP AVE, EDGEWATER, FL 32132-1555
(386) 957-4100
(386) 957-4104
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
08/06/2019
Last updated
04/26/2022
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