Provider Demographics
NPI:1578116042
Name:CIRCOSTA, MARIA JOSEPHINA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSEPHINA
Last Name:CIRCOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-9511
Mailing Address - Country:US
Mailing Address - Phone:540-828-2634
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-9511
Practice Address - Country:US
Practice Address - Phone:540-828-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001265370163W00000X
VA0024177933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024177933OtherBOARD OF NURSING/BOARD OF MEDICINE