Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Coastal Vascular and Interventional PLLC

Organization Diagnostic Radiology Physician · NPI 1164091005

Coastal Vascular and Interventional PLLC is a Diagnostic Radiology Physician in Fort Walton Beach, Florida. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
3
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1032 Mar Walt Dr Unit 250
Fort Walton Beach, FL 32547-6663
Phone: (850) 479-1805
Fax: (850) 479-1829
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X
Diagnostic Radiology Physician Taxonomy 2085R0202X
Vascular & Interventional Radiology Physician Taxonomy 2085R0204X

Record details

NPI number1164091005
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Danelle Fischer — Administrator · (850) 479-1805
NPI enumeratedJune 24, 2021
Last updated in NPPESJune 24, 2021
Certification dateJune 24, 2021
Mailing addressPo Box 11982, Pensacola, FL 32524-1982

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