Organization
COASTAL COSMETIC CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA A HARMS (ADMINISTRATOR)
(904) 332-6774
Entity
Organization
Contact information
Practice address
4147 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
(904) 332-6774
(904) 332-9137
Mailing address
4147 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
(904) 332-6774
(904) 332-9137
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97148
BCBS GROUP
FL
Enumeration date
06/24/2006
Last updated
08/22/2020
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