Provider Demographics
NPI:1396837043
Name:COSTANZO, SHARON BRENEMAN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BRENEMAN
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 NW 80TH CIR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4749
Mailing Address - Country:US
Mailing Address - Phone:954-815-0037
Mailing Address - Fax:
Practice Address - Street 1:10284 NW 47 STREET
Practice Address - Street 2:NP CARE, LLC
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-578-3237
Practice Address - Fax:954-575-0000
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL787612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0535ZMedicare ID - Type Unspecified
FLP86967Medicare UPIN