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General NPI Number Information
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NPI Number | 1932884368
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Entity Type | Individual
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Provider Name | MISS EKATERINA KOSTYLEVA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 3307 NORTHLAKE BLVD STE 103
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1703
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Country | US
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Telephone | 786-622-2871
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Fax |
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Provider Business Mailing Address
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Address Line | 180 NE 12TH AVE APT 10B
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4550
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Country | US
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Telephone | 786-438-6737
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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 | 11026614
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License Number State | FL
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