Costello, David M

Costello, David M is an individual health care provider with primary practice located at 1285 Orange Ave , Winter Park FL 32789-4984. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Costello, David M can be contacted via phone (407) 599-3710.

Contact Information

Primary practice address
1285 Orange Ave Winter Park FL 32789-4984
Phone: (407) 599-3710
Fax: (407) 643-2807
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2227 Florida

Profile Details

NPI number 1972588408
LBN Legal business name Costello, David M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Nov 24th, 2020 - about 6 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 1972588408 NPPES
Florida MEDICAID 290340700

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