Healthcare Provider Details

I. General information

NPI: 1518681006
Provider Name (Legal Business Name): REBEKAH JO COSTELLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 SW HIGHWAY 200 STE 301
OCALA FL
34481-9648
US

IV. Provider business mailing address

9401 SW HIGHWAY 200 STE 301
OCALA FL
34481-9648
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-9459
  • Fax: 352-291-9465
Mailing address:
  • Phone: 352-291-9459
  • Fax: 352-291-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11021407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: