Individual
KATHERINE ELIZABETH COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
14780 W MOUNTAIN VIEW BLVD, SUITE 110, SURPRISE, AZ 85374-4799
(623) 374-7774
Mailing address
14780 W MOUNTAIN VIEW BLVD, SUITE 110, SURPRISE, AZ 85374-4799
(623) 374-7774
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
R862053
MS
363L00000X
Nurse Practitioner
Primary
AP3211
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05132705
—
MS
01
—
P00143146
MEDICARE UNITEDHEALTHCARE
MS
Enumeration date
11/01/2006
Last updated
09/17/2021
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