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General NPI Number Information
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NPI Number | 1578802864
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Entity Type | Individual
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Provider Name | JOSEPH L COSTA CRNP
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Gender | Male
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 460 RIVER AVE
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City | WILLIAMSPORT
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State | PA
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Zip | 17701
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Country | US
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Telephone | 570-213-5221
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Fax | 570-227-3316
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE CREDENTIALS DEPT
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City | DANVILLE
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State | PA
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Zip | 17822-4903
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Country | US
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Telephone | 570-271-6144
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP012744
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License Number State | PA
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