MEDICARE: MICHAEL COSTANZO 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	363L00000X	Nurse Practitioner	APRN.CNP.0039698	OH

General Provider Information

NPI Number	:	1245984665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL COSTANZO NP

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE STE 2
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:	330-947-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 HAPPY HOLLOW RD
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-1848
Country	:	US
Telephone Number	:	513-327-9244
Fax Number	:	513-323-5201

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

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	09/16/2025

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