Individual
AMANDA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
18958 N DALE MABRY HWY, LUTZ, FL 33548-2829
(813) 839-7390
(813) 333-5994
Mailing address
9310 HERITAGE OAK CT, TAMPA, FL 33647-5013
(727) 808-0959
(813) 333-5994
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP 9415070
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP013276
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01567509
—
FL
Enumeration date
10/16/2013
Last updated
07/21/2022
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