Healthcare Provider Details

I. General information

NPI: 1114612025
Provider Name (Legal Business Name): NISHANTHI BURNICE COSTAS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISHANTHI BURNICE KULENTHIRARAJAN

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MIDDLESEX TPKE STE 3110
BURLINGTON MA
01803-5358
US

IV. Provider business mailing address

85 MIDDLESEX TPKE STE 3110
BURLINGTON MA
01803-5358
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2295823
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2295823
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2295823
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: