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COASTLINE NEUROPSYCHIATRIC, PLLC - Florida Company Profile

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Company Details

Entity Name: COASTLINE NEUROPSYCHIATRIC, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 May 2023 (2 years ago)
Document Number: L23000245978
FEI/EIN Number 93-1481966
Address: 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501, US
Mail Address: 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501, US
ZIP code: 32501
City: Pensacola
County: Escambia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
GROOM KEVIN N Authorized Member 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501
GROOM KEVIN N Agent 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501

National Provider Identifier

NPI Number:
1043996986
Certification Date:
2023-10-06

Authorized Person:

Name:
DR. KEVIN NEIL GROOM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
103G00000X - Clinical Neuropsychologist
Is Primary:
Yes

Contacts:

Fax:
8504331996

Documents

Name Date
ANNUAL REPORT 2024-04-27
Florida Limited Liability 2023-05-18

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Date of last update: 03 Aug 2025

Sources: Florida Department of State