Individual
MRS. DIANA M COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2817 REILLY ST, FORT BRAGG, NC 28310-4712
(910) 907-8500
Mailing address
4301 JONES BRIDGE RD, BETHESDA, MD 20814-4712
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95015129
CA
390200000X
Student in an Organized Health Care Education/Training Program
736894
CA
Other
Enumeration date
12/13/2017
Last updated
05/17/2022
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