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NPI Code Detail

MEDICARE: KAILAH COSTELLO APRN

MEDICARE: KAILAH COSTELLO APRN
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
1363LF0000XFamily Nurse PractitionerAPRN11015745FL

General Provider Information

NPI Number : 1962169821
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILAH COSTELLO APRN
Provider Business Mailing Address
First Line : 1600 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-3065
Country : US
Telephone Number : 863-680-7000
Fax Number : 866-264-8519
Provider Business Practice Location Address
First Line : 1600 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-3065
Country : US
Telephone Number : 863-680-7390
Fax Number : 866-264-8519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2021
Last Update Date : 01/16/2026

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Directions to “ KAILAH COSTELLO APRN” Practice Location

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