MEDICARE: LAURA COSTERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP3367272	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366871980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA COSTERO

Provider Business Mailing Address
First Line	:	9009 CORPORATE LAKE DR
Second Line	:	SUITE 200
City	:	TAMPA
State	:	FL
Zip	:	33634-2367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8260 W FLAGLER ST STE 2I
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-2069
Country	:	US
Telephone Number	:	786-715-9183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/26/2024

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Directions to “ LAURA COSTERO ” Practice Location

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