Healthcare Provider Details

I. General information

NPI: 1932998622
Provider Name (Legal Business Name): KIMBERLY ANN COSTA-WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12823 SOLOLA WAY
TRINITY FL
34655-7246
US

IV. Provider business mailing address

15832 SEA PINES DR
HUDSON FL
34667-4048
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-6042
  • Fax:
Mailing address:
  • Phone: 727-389-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: