MEDICARE: MRS. DENISE K COSTA FAMILY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9277041	FL

General Provider Information

NPI Number	:	1013991629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE K COSTA FAMILY NP

Provider Business Mailing Address
First Line	:	2560 COMMERCE PKWY
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9348
Country	:	US
Telephone Number	:	941-429-3545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 COMMERCE PKWY
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9348
Country	:	US
Telephone Number	:	941-429-3545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	10/03/2012

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