Provider Demographics
NPI:1033434972
Name:COSTA, AMY K (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:COSTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2047
Mailing Address - Country:US
Mailing Address - Phone:330-812-0499
Mailing Address - Fax:
Practice Address - Street 1:544 AVALON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2047
Practice Address - Country:US
Practice Address - Phone:330-812-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN321202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse