MEDICARE: CELINA COSTA PA-C

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	207Q00000X	Family Medicine Physician	25MP00496700	NJ
2	363A00000X	Physician Assistant
3	363A00000X	Physician Assistant	PA9112376	FL

General Provider Information

NPI Number	:	1912482282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELINA COSTA PA-C

Provider Business Mailing Address
First Line	:	8229 NW 88TH AVE
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-1541
Country	:	US
Telephone Number	:	754-222-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	8229 NW 88TH AVE
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-1541
Country	:	US
Telephone Number	:	754-222-8232
Fax Number	:

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	01/21/2025

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Directions to “ CELINA COSTA PA-C” Practice Location

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