Provider Demographics
NPI:1407472855
Name:COSTIUC, NATHAN (APRN)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:COSTIUC
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 SUNDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7714
Mailing Address - Country:US
Mailing Address - Phone:561-727-9654
Mailing Address - Fax:
Practice Address - Street 1:2036 SUNDERLAND AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-7714
Practice Address - Country:US
Practice Address - Phone:561-727-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily