Provider Demographics
NPI:1508357922
Name:COSTANZA, ELIZABETH A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:COSTANZA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:98 JAMES ST STE 313
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-635-1100
Mailing Address - Fax:732-635-0918
Practice Address - Street 1:98 JAMES ST STE 313
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-635-1100
Practice Address - Fax:732-635-0918
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00801900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology