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General NPI Number Information
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NPI Number | 1821797135
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Entity Type | Individual
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Provider Name | ALLA KOSTOV
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Gender | Female
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1370 E VENICE AVE STE 202
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City | VENICE
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State | FL
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Zip | 34285-9084
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Country | US
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Telephone | 941-480-0500
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Fax | 941-480-9322
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 778-563-7748
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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 | RN9554103
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11035174
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License Number State | FL
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