Coast Port Charlotte, P.L.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

COAST PORT CHARLOTTE, P.L.

Practice address

4010 W Boy Scout Blvd
Suite 1100-Credentialing
Tampa, FL 33607-5727

Phone

(813) 288-1999

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Darlene Finnell

Title

Director of Ins. and Credentialing

Phone

(813) 288-1999

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1164513230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 W BOY SCOUT BLVD",
            "address_2": "SUITE 1100-CREDENTIALING",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 W BOY SCOUT BLVD",
            "address_2": "SUITE 1100-CREDENTIALING",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075727",
            "telephone_number": "813-288-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST PORT CHARLOTTE, P.L.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "FINNELL",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "DIRECTOR OF INS. AND CREDENTIALING",
        "authorized_official_telephone_number": "813-288-1999"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.