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Organization

COASTAL PHYSICIAN CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEREMY L DARSTEK (CEO)
(239) 898-3836
Entity
Organization

Contact information

Practice address
9250 CORKSCREW RD, SUITE 3, ESTERO, FL 33928-3208
(239) 498-2528
Mailing address
1865 VETERANS PARK DR STE 202, NAPLES, FL 34109-0447
(239) 898-3836

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207QA0000X
Adolescent Medicine (Family Medicine) Physician
207QA0505X
Adult Medicine Physician
207QG0300X
Geriatric Medicine (Family Medicine) Physician
207R00000X
Internal Medicine Physician
207RG0300X
Geriatric Medicine (Internal Medicine) Physician

Other

Enumeration date
11/05/2014
Last updated
11/05/2014
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