Nurse Practitioner, Primary Care
COASTAL COMMUNITY CENTER INC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1295690527 · enumerated 2025-12-18 · record updated 2025-12-18. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: AYUSHMAAN SRINIVASA, Board Member · (702) 809-2505
Addresses and phones
- Mailing address 3650 N UNIVERSITY AVE STE 150, PROVO, UT, 84604-6636 Google Maps Apple Maps OpenStreetMap
- Practice location 3650 N UNIVERSITY AVE STE 150, PROVO, UT, 84604-6636 (702) 809-2505 Google Maps Apple Maps OpenStreetMap
Specialties
- Internal Medicine 207R00000X
- Nurse Practitioner, Primary Care 363LP2300X · Primary
In this directory
Locations and evidence
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Practice location
PROVO, UT, 846046636
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.