Healthcare Provider Details

I. General information

NPI: 1275456162
Provider Name (Legal Business Name): COSTIN MARIAN JAMES HEWITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 POLK AVE
PENSACOLA FL
32507-1866
US

IV. Provider business mailing address

908 POLK AVE
PENSACOLA FL
32507-1866
US

V. Phone/Fax

Practice location:
  • Phone: 448-210-2464
  • Fax:
Mailing address:
  • Phone: 448-210-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberL26000365368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: