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General NPI Number Information
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NPI Number | 1932998622
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Entity Type | Individual
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Provider Name | KIMBERLY ANN COSTA-WHITE
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 12823 SOLOLA WAY
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City | TRINITY
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State | FL
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Zip | 34655-7246
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Country | US
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Telephone | 727-534-6042
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Fax |
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Provider Business Mailing Address
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Address Line | 15832 SEA PINES DR
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City | HUDSON
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State | FL
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Zip | 34667-4048
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Country | US
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Telephone | 727-389-7115
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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