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

Coastline Medical Services PLLC

Organization Sports Medicine (Family Medicine) Physician · NPI 1003361767

Coastline Medical Services PLLC is a Sports Medicine (Family Medicine) Physician in Fort Walton Beach, Florida. Licensed in Florida. Registered with an NPI since 2016.

Licensed in
FL
In the registry since
2016
Specialties on file
2
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

1817 Lewis Turner Blvd Ste F
Fort Walton Beach, FL 32547-1349
Phone: (850) 396-1110
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Specialty Clinic/Center (primary) Taxonomy 261QM2500X · Licence ME116308 (FL)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X

Record details

NPI number1003361767
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Tavernaris — Physician · (850) 396-1110
NPI enumeratedAugust 23, 2016
Last updated in NPPESSeptember 27, 2024
Certification dateSeptember 27, 2024
Mailing address208 Mary Esther Blvd, Mary Esther, FL 32569-1687

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