Healthcare Provider Details

I. General information

NPI: 1083796825
Provider Name (Legal Business Name): MARY KAREN KOSTENBAUDER ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 BURL WAY
ORLANDO FL
32817-4253
US

IV. Provider business mailing address

9950 BURL WAY
ORLANDO FL
32817-4253
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-5075
  • Fax:
Mailing address:
  • Phone: 407-325-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP641142
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP641142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: