COASTAL FOOT & ANKLE WELLNESS CENTER LLC (NPI# 1972834760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972834760 |
| Entity Type | Organization |
| Organization Name | COASTAL FOOT & ANKLE WELLNESS CENTER LLC |
| Practice Address |
200 Southpark Blvd Suite 208 St Augustine FL 32086-3129 |
| Practice Telephone | 9048261900 |
| Mailing Telephone | 9048261900 |
| Mailing Fax Number | 9048261920 |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2010-05-10 |
| Authorized Official Name | DR. RICHARD W JOHNSON (OWNER) |
| Authorized Official Telephone | 9048261900 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
P02829 | FL | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS OF FLORIDA | 000NU | 01 |
| Street Address |
200 SOUTHPARK BLVD SUITE 208 |
| City | ST AUGUSTINE |
| State | FL |
| Zip Code | 32086-3129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841293982 | Medfund LLC | Clinic/Center | 200 Southpark Blvd, Ste 210, St Augustine, FL 32086-3101 | 2005-05-23 |
| 1124680996 | Julie Marie Jabour | Speech-Language Pathologist | 200 Southpark Blvd, St Augustine, FL 32086-3129 | 2019-07-02 |
| 1235790684 | Kayla Kathleen Evans | Speech-Language Pathologist | 200 Southpark Blvd, St Augustine, FL 32086-3129 | 2019-06-26 |
| 1124266010 | A1 Imaging of St Augustine LLC | Clinic/Center | 200 Southpark Blvd, Ste 210, St Augustine, FL 32086-3101 | 2009-01-30 |
| 1265691208 | A1 Imaging of St Augustine | Clinic/Center | 200 Southpark Blvd, Suite 210, St Augustine, FL 32086-3101 | 2008-06-05 |
| 1477590248 | Richard W Johnson | Podiatrist | 200 Southpark Blvd, Ste 208, St Augustine, FL 32086-3129 | 2006-06-01 |
| 1992742142 | Jose M Concha | Podiatrist | 200 Southpark Blvd, Suite 208, St Augustine, FL 32086-3129 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225670037 | Ramonica Flagler | Nurse Practitioner | 3574 Us-1 South, St. Augustine, FL 32086 | 2019-10-14 |
| 1518522648 | Marissa Marie Lynch | Physician Assistant | 100 Whetstone Pl Ste 102, St Augustine, FL 32086 | 2019-05-03 |
| 1346706991 | Castillo Transportation | Non-emergency Medical Transport (VAN) | 295 North Hidden Tree Dr, Saint Augustine, FL 32086 | 2019-02-19 |
| 1790255842 | Michelle Moore | In Home Supportive Care | 135 Jenkins St. Suite 105b #265, St.augustine, FL 32086 | 2018-12-03 |
| 1649740200 | Paul James Lietz IIi | Physical Therapist | One Orthopedic Place, Saint Augustine, FL 32086 | 2018-11-27 |
| 1548764707 | Oceanside Endodontics Od St. Augustine | Dentist | 2510 U.S. 1 South, Suite B, St. Augustine, FL 32086 | 2018-03-22 |
| 1023538329 | Joseph R Edwards | Physical Therapist | 968 Espinado Avenue, St Augustine, FL 32086 | 2017-06-27 |
| 1235662032 | Jennifer L Csenge | Dentist | 4327 Us Highway 1 S, St Augustine, FL 32086 | 2017-04-07 |
| 1336683663 | Lisa Brice | Social Worker | 248 Southpark Circle East, Saint Augustine, FL 32086 | 2016-12-06 |
| 1558813303 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 65 Whitehall Drive, Saint Augustine, FL 32086 | 2016-10-27 |
| Find all providers in zip 32086 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659587897 | Thomas Anthony Lebeau | Podiatrist | 1 Saint Johns Medical Park Dr, St Augustine, FL 32086-5300 | 2007-05-15 |
| 1578576179 | Rosana Rodriguez | Podiatrist | 6 Saint Johns Medical Park Dr, St Augustine, FL 32086-4233 | 2006-08-14 |
| 1841237864 | John A Cunningham | Podiatrist | 3829 Paddington Pl, St Augustine, FL 32092-3660 | 2006-05-31 |
| 1972994770 | Emmanuel Lagoutaris, Dpm, LLC | Podiatrist | 300 Kingsley Lake Dr, Ste. 402, St Augustine, FL 32092-3037 | 2015-02-15 |
| 1376887661 | Hany M Jeffry | Podiatrist | 6 Saint Johns Medical Park Dr, St Augustine, FL 32086-5298 | 2012-11-27 |
| 1649409756 | St. Augustine Foot & Ankle, Inc | Podiatrist | 1 Saint Johns Medical Park Dr, St Augustine, FL 32086-5300 | 2009-07-09 |
| 1730354523 | Community Podiatry & Wound Care Pa | Podiatrist | 6 Saint Johns Medical Park Dr, St Augustine, FL 32086-4233 | 2008-04-23 |
| 1033195979 | Ryan J Pereira | Podiatrist | 1301 Plantation Island Dr S, Ste 203, St Augustine, FL 32080-3108 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693120 | Mozhgan Alijani, Dpm, Pa | Podiatrist | 20515 E Country Club Dr Apt 544, Miami, FL 33180-3442 | 2020-09-11 |
| 1730790551 | Sacred Heart Hospital of Pensacola | Podiatrist | 1890 Summit Blvd, Pensacola, FL 32503 | 2020-08-14 |
| 1306457841 | Asdj LLC | Podiatrist | 2190 Bridgeport Cir, Rockledge, FL 32955-4338 | 2020-08-10 |
| 1316557762 | Upperline Healthcare, PC | Podiatrist | 2111 Glenwood Dr Ste 104, Winter Park, FL 32792-3328 | 2020-07-31 |
| 1790395135 | Upperline Healthcare, PC | Podiatrist | 339 Cypress Pkwy Ste 240, Kissimmee, FL 34759-3315 | 2020-07-31 |
| 1952911398 | Upperline Healthcare, PC | Podiatrist | 250 N Alafaya Trl Ste 115, Orlando, FL 32828-4336 | 2020-07-31 |
| 1639789076 | Upperline Healthcare, PC | Podiatrist | 650 S Courtenay Pkwy Ste 200, Merritt Island, FL 32952-4977 | 2020-07-31 |
| 1972113314 | Upperline Healthcare, PC | Podiatrist | 8000 Red Bug Lake Rd Ste 230, Oviedo, FL 32765-9265 | 2020-07-31 |
| 1356950646 | Palm Beach Foot & Ankle Inc | Podiatrist | 8130 Royal Palm Blvd Ste 205, Coral Springs, FL 33065-5703 | 2020-07-23 |
| 1720601891 | Yohandy Fuentes Dpm Pa | Podiatrist | 5200 Sw 8th St Ste 201a, Coral Gables, FL 33134-2337 | 2020-05-24 |
| Find all providers with the same taxonomy | ||||
| City | ST AUGUSTINE |
| Zip Code | 32086 |
Please comment or provide details below to improve the information on COASTAL FOOT & ANKLE WELLNESS CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.