Provider Demographics
NPI:1215374038
Name:COSTA, NANCY ELIZABETH (DO)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:COSTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 DARST RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3442
Mailing Address - Country:US
Mailing Address - Phone:937-531-0132
Mailing Address - Fax:937-531-0134
Practice Address - Street 1:68 DARST RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3442
Practice Address - Country:US
Practice Address - Phone:937-531-0132
Practice Address - Fax:937-531-0134
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34.011541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty