OrganizationActive
Coastal Community Center Inc
NPI 1295690527 · Primary Care Nurse Practitioner · Provo, UT
Provider details
- NPI number
- 1295690527
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Ayushmaan Srinivasa, Board Member(702) 809-2505
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
Practice location
3650 N University Ave Ste 150
Provo, UT 84604-6636
Phone: (702) 809-2505
Approximate (ZIP-level) locationGet directions
Mailing address
3650 N University Ave Ste 150
Provo, UT 84604-6636
Registry dates
- Enumerated
- 2025-12-18
- Last updated
- 2025-12-18
- Certified
- 2025-12-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.