Costello, Amanda

Costello, Amanda is an individual health care provider with primary practice located at 18958 N Dale Mabry Hwy , Lutz FL 33548-2829. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Costello, Amanda can be contacted via phone (813) 839-7390.

Contact Information

Primary practice address
18958 N Dale Mabry Hwy Lutz FL 33548-2829
Phone: (813) 839-7390
Fax: (813) 333-5994
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X SP013276 Pennsylvania
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X ARNP 9415070 Florida

Profile Details

NPI number 1346678026
LBN Legal business name Costello, Amanda
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2013
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346678026 NPPES
Florida MEDICAID 01567509

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