Provider Demographics
NPI:1891382867
Name:COSTA GOVEA, ERNESTO ANGEL (ARNP)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ANGEL
Last Name:COSTA GOVEA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:ERNESTO
Other - Middle Name:ANGEL
Other - Last Name:COSTA GOVEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:14258 SW 101ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6967
Mailing Address - Country:US
Mailing Address - Phone:305-639-0556
Mailing Address - Fax:
Practice Address - Street 1:14258 SW 101ST LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6967
Practice Address - Country:US
Practice Address - Phone:305-639-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily