Provider Demographics
NPI:1760540025
Name:COSTANTINO, DEBRA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:COSTANTINO
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 1:9910 SANDALFOOT BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6692
Mailing Address - Country:US
Mailing Address - Phone:561-883-3030
Mailing Address - Fax:561-852-7611
Practice Address - Street 1:9910 SANDALFOOT BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6692
Practice Address - Country:US
Practice Address - Phone:561-883-3030
Practice Address - Fax:561-852-7611
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1461542363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q76825Medicare UPIN
FLAB637YMedicare PIN