Provider Demographics
NPI:1164975413
Name:DACOSTA, LAMESHIA M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAMESHIA
Middle Name:M
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAMESHIA
Other - Middle Name:M
Other - Last Name:DACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST FL 45
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2942
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400162815Medicare PIN