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General NPI Number Information
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NPI Number | 1356990816
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Entity Type | Individual
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Provider Name | JENNA MARIANNA COSTA APN/CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 5352 LINTON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6514
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Country | US
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Telephone | 561-498-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 445 NE 37TH ST
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City | BOCA RATON
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State | FL
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Zip | 33431-5925
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Country | US
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Telephone | 862-377-8564
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9487244
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11004317
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License Number State | FL
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