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General NPI Number Information
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NPI Number | 1982162673
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Entity Type | Individual
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Provider Name | SUSANNA MARIE COSTELLO ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 38184 MEDICAL CENTER AVE
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City | ZEPHYRHILLS
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State | FL
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Zip | 33540-1380
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Country | US
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Telephone | 813-715-2812
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Fax | 813-715-2814
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Provider Business Mailing Address
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Address Line | 1725 OAKWOOD CT
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City | LUTZ
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State | FL
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Zip | 33558-5218
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Country | US
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Telephone | 813-267-7888
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP11001077
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License Number State | FL
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