Doctor Name: | MRS. DENISE K COSTA |
NPI Number: | 1013991629 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FAMILY NP |
License Number: | 9277041 |
Business Practice Address: | 2560 Commerce Pkwy North Port, FL - 342899348 |
Business Phone Number: | 9414293545 |
Business Fax Number: | |
Mailing Address: | 2560 Commerce Pkwy, NORTH PORT |
State: | FL |
Postal Code: | 342899348 |
Phone Number: | 9414293545 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2005 |
NPI Last Update Date: | 10/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 9277041 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |