Individual
MRS. ERIN R COSTANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNPC
Contact information
Practice address
7869 VILLA RICA HWY, DALLAS, GA 30157
(770) 459-4411
(770) 459-2424
Mailing address
PO BOX 608, VILLA RICA, GA 30180
(770) 459-4411
(770) 459-2424
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN146776NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
453616500A
—
GA
05
—
453616500B
—
GA
Enumeration date
02/14/2006
Last updated
01/19/2010
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