MEDICARE: ANTHONY DICOSTANZO 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	11039273	FL

General Provider Information

NPI Number	:	1891584777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY DICOSTANZO NP

Provider Business Mailing Address
First Line	:	401 VENTURE DR
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3478
Country	:	US
Telephone Number	:	386-837-0958
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 VENTURE DR
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3478
Country	:	US
Telephone Number	:	386-761-8888
Fax Number	:

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	03/11/2026

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