OrganizationActive
Coastal Esthetics, LLC
NPI 1114572245 · Adult Medicine Physician · Edgewater, FL
Provider details
- NPI number
- 1114572245
- Entity type
- Organization
- Primary specialty
- Adult Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Carissa Peterson, Owner/Aprn(386) 957-4100
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(66/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
109 W Knapp Ave
Edgewater, FL 32132-1555
Phone: (386) 957-4100
Fax: (386) 957-4104
Street-level locationGet directions
Mailing address
109 W Knapp Ave
Edgewater, FL 32132-1555
Other names (DBA / former)
- Doing business as
- Coastline Primary Care
- Doing business as
- Coastline Primary Care
Registry dates
- Enumerated
- 2019-08-06
- Last updated
- 2022-04-26
- Certified
- 2022-04-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.