Provider Demographics
NPI:1053034595
Name:NATURE COAST CRUISERS LLC
Entity type:Organization
Organization Name:NATURE COAST CRUISERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAQUANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-642-2880
Mailing Address - Street 1:1153 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4541
Mailing Address - Country:US
Mailing Address - Phone:727-642-2880
Mailing Address - Fax:
Practice Address - Street 1:1153 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4541
Practice Address - Country:US
Practice Address - Phone:727-642-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)