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General NPI Number Information
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NPI Number | 1053826297
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Entity Type | Individual
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Provider Name | OPHELIA DACOSTA-GREEN APRN
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2217 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-421-3456
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Fax | 863-421-3466
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Provider Business Mailing Address
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Address Line | 6311 NW 2ND ST
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City | MARGATE
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State | FL
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Zip | 33063-5156
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Country | US
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Telephone | 954-592-7947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9199962
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License Number State | FL
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