| Coastal Community Health Services, Inc. | |
|
22385 Flora Park Crossing Drive Fernandina Beach FL 32034 | |
| (904) 404-8641 | |
| (904) 227-3246 |
| Full Name | Coastal Community Health Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 22385 Flora Park Crossing Drive, Fernandina Beach, Florida |
| Authorized Official Name and Position | Kavanaugh Chandler (CEO) |
| Authorized Official Contact | 9122758028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Community Health Services, Inc. 100 Professional Center Dr Brunswick GA 31525-6743 Ph: (912) 574-5075 | Coastal Community Health Services, Inc. 22385 Flora Park Crossing Drive Fernandina Beach FL 32034 Ph: (904) 404-8641 |
| NPI Number | 1851131874 |
|---|---|
| Provider Enumeration Date | 05/28/2024 |
| Last Update Date | 05/28/2024 |
| Medicare PECOS PAC ID | 0345463683 |
|---|---|
| Medicare Enrollment ID | O20241112000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851131874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Kena R Watkins-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912159666 PECOS PAC ID: 9436316908 Enrollment ID: I20120210000681 |
| Provider Name | Parikshit Deshmukh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437395845 PECOS PAC ID: 3173789948 Enrollment ID: I20120723000717 |
| Provider Name | Lisa Sweeney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093235731 PECOS PAC ID: 1557634656 Enrollment ID: I20170912003310 |
| Provider Name | Kimberly H Clayton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447759543 PECOS PAC ID: 1850654195 Enrollment ID: I20180418002752 |
| Provider Name | King D Mungin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174042212 PECOS PAC ID: 2860755162 Enrollment ID: I20180419002384 |
| Provider Name | Darneisha Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063926319 PECOS PAC ID: 4284998048 Enrollment ID: I20180502000548 |
| Provider Name | John J Kemerer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386696599 PECOS PAC ID: 4385657022 Enrollment ID: I20180518000198 |
| Provider Name | Cory Mccormick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861940819 PECOS PAC ID: 1052609880 Enrollment ID: I20180905000398 |
| Provider Name | Erika Charrell Albertie-young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508530668 PECOS PAC ID: 2668877937 Enrollment ID: I20210825000234 |
| Provider Name | Joel Socarras-rosa |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780866541 PECOS PAC ID: 3779649884 Enrollment ID: I20210927001382 |
| Provider Name | Sabrina M Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316172851 PECOS PAC ID: 0446559140 Enrollment ID: I20220427002243 |
| Provider Name | Audrey Kathryn Dona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598486482 PECOS PAC ID: 9739557265 Enrollment ID: I20221115000542 |
| Provider Name | Nancy Motherway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548509219 PECOS PAC ID: 5496133621 Enrollment ID: I20230130002672 |
| Provider Name | Tania Sophia Harvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295445914 PECOS PAC ID: 4284008244 Enrollment ID: I20230315001178 |
| Provider Name | Mandy Jo Roth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558056671 PECOS PAC ID: 8921465105 Enrollment ID: I20230602000601 |
| Provider Name | Jenrry Medinilla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760173660 PECOS PAC ID: 1254798085 Enrollment ID: I20230608002875 |
| Provider Name | Timothy Mahaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386329514 PECOS PAC ID: 8224498613 Enrollment ID: I20230717003156 |
| Provider Name | Samuel Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811674757 PECOS PAC ID: 3577917590 Enrollment ID: I20230925003806 |
| Provider Name | Kandis Hull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912685751 PECOS PAC ID: 4880049519 Enrollment ID: I20231016001168 |
| Provider Name | Stephanie Marin-field |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528484938 PECOS PAC ID: 1759739162 Enrollment ID: I20231126000038 |
| Provider Name | Courtny Coerver |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811551294 PECOS PAC ID: 4385084680 Enrollment ID: I20240503001476 |
| Provider Name | Nicole Gabana |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700481785 PECOS PAC ID: 2466892575 Enrollment ID: I20240506003219 |
| Provider Name | Terran C Dillhyon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265293591 PECOS PAC ID: 9537501598 Enrollment ID: I20240523000108 |
| Provider Name | Elizabeth Suzanne Balser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881181568 PECOS PAC ID: 1759826431 Enrollment ID: I20240717004246 |
| Provider Name | Ericka Burnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093586406 PECOS PAC ID: 5092253021 Enrollment ID: I20240821001671 |
| Provider Name | Mary Sarfo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386494185 PECOS PAC ID: 4082154133 Enrollment ID: I20240904003331 |
| Provider Name | Christian Dopico |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295239820 PECOS PAC ID: 7911448691 Enrollment ID: I20240920003148 |
| Provider Name | Mary Margaret Schlosser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033951389 PECOS PAC ID: 2668906702 Enrollment ID: I20241112000992 |
| Provider Name | Kervin Isaac |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679343982 PECOS PAC ID: 6800321357 Enrollment ID: I20241121001416 |
| Provider Name | Adrieene Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386487502 PECOS PAC ID: 2163958794 Enrollment ID: I20241206000359 |
| Provider Name | Dennis Horner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669794160 PECOS PAC ID: 7214116672 Enrollment ID: I20241219003710 |
| Provider Name | Karine Lubin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114334810 PECOS PAC ID: 8325576275 Enrollment ID: I20250107000026 |
| Provider Name | Sahiris Aponte |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659946879 PECOS PAC ID: 5597293696 Enrollment ID: I20250116000854 |
| Provider Name | Katrina Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598200115 PECOS PAC ID: 7416477732 Enrollment ID: I20250217003197 |
Hospitalists Of Northeast Florida Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1250 S 18th St, Hospitalists Of Northeast Florida Inc, Fernandina Beach, FL 32034 Phone: 904-396-5682 Fax: 904-346-0864 | |
Flip Flops And Lollipops Pediatrics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22455 Flora Parke Xing, Fernandina Beach, FL 32034 Phone: 904-572-1884 Fax: 904-491-1118 | |
Amelia Internal Medicine,p.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1250 S 18th St, Suite 202, Fernandina Beach, FL 32034 Phone: 904-277-4690 Fax: 904-277-8487 | |
Baptist Primary Care Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 S 14th St, Fernandina Beach, FL 32034 Phone: 904-491-3688 Fax: 904-261-6680 | |
Seadipity Wellness Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 22455 Flora Parke Xing, Fernandina Beach, FL 32034 Phone: 904-452-4790 Fax: 833-907-2436 | |
Barnabas Health Services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1303 Jasmine St, Suite 101, Fernandina Beach, FL 32034 Phone: 904-261-7000 Fax: 904-261-8899 | |
Diana R Twiggs Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1888 S 14th St, Fernandina Beach, FL 32034 Phone: 904-261-0922 |