Healthcare Provider Details

I. General information

NPI: 1356373732
Provider Name (Legal Business Name): JODY L. COSTANZO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SE 18TH ST STE 203
OCALA FL
34471-5441
US

IV. Provider business mailing address

1630 SE 18TH ST STE 203
OCALA FL
34471-5441
US

V. Phone/Fax

Practice location:
  • Phone: 352-612-3739
  • Fax: 352-355-2982
Mailing address:
  • Phone: 352-612-3739
  • Fax: 352-355-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: