Coastal Community Center Inc

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

COASTAL COMMUNITY CENTER INC

Practice address

3650 N University Ave Ste 150
Provo, UT 84604-6636

Phone

(702) 809-2505

NPI assigned

Dec 18, 2025

Organization subpart

No

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

Authorized official

Name

Ayushmaan Srinivasa

Title

Board Member

Phone

(702) 809-2505

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1295690527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 N UNIVERSITY AVE STE 150",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 N UNIVERSITY AVE STE 150",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046636",
            "telephone_number": "702-809-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL COMMUNITY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-18",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "SRINIVASA",
        "authorized_official_first_name": "AYUSHMAAN",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "702-809-2505"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Aubree Cluff
• William Reid Cluff, OD
• Jessica Ray Clyde, LPN
• Sam J Coates, MD
• Megan Cobabe
• Melanie Ann Cobabe, M.S.
• Andrew Evans Cobb
• Justus Cobb

• Primary Care Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Primary Care Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; 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.