Individual
SHELBY ANN COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 841-1893
(321) 841-1296
Mailing address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 841-1893
(321) 841-1296
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9114837
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111898400
—
FL
Enumeration date
05/26/2021
Last updated
12/05/2022
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