NPIMap

Organization Active NPI

Coastal Care & Dermatology, LLC

  • Nurse Practitioner
  • Millsboro, DE
National Provider Identifier
1053838896
Registry record updated Aug 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
COASTAL CARE & DERMATOLOGY, LLC
Practice address
28524 Dupont Blvd
Millsboro, DE 19966-4777
Phone
(302) 542-4999
NPI assigned
Aug 23, 2017
Last updated
Aug 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy O'Day, FNP
Title
FNP
Phone
(302) 542-8291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

28524 Dupont Blvd
Millsboro, DE 19966-4777

Mailing address

87 Delaware Ave
Millsboro, DE 19966-1798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170929000116 DE Part B Supplier - Clinic/Group Practice 4981979010 Receives reassigned benefits from 2 practitioners
Practice locations: Millsboro, DE

National Provider Directory

National Provider Directory

Locations

28524 DuPont Blvd
Millsboro, DE 19966
Phone (302) 542-4999

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503446400000",
    "number": "1053838896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 DELAWARE AVE",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199661798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28524 DUPONT BLVD",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199664777",
            "telephone_number": "302-542-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARE & DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-23",
        "last_updated": "2017-08-23",
        "status": "A",
        "authorized_official_last_name": "O'DAY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "302-542-8291",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millsboro, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.