MEDICARE: LEIGH ANNE COSTANZO

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	207Q00000X	Family Medicine Physician	007894	AZ

General Provider Information

NPI Number	:	1932563392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH ANNE COSTANZO

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	615-314-5257
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 E SOUTHERN AVE STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5058
Country	:	US
Telephone Number	:	480-610-7100
Fax Number	:	480-870-7402

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	01/26/2023

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Directions to “ LEIGH ANNE COSTANZO ” Practice Location

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